Provider Demographics
NPI:1902828015
Name:MCNELIS, DONNA LEIGH (RD,LD)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEIGH
Last Name:MCNELIS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FAIRPARK LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3500
Mailing Address - Country:US
Mailing Address - Phone:404-370-6033
Mailing Address - Fax:
Practice Address - Street 1:24 FAIRPARK LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3500
Practice Address - Country:US
Practice Address - Phone:404-370-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002900133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered