Provider Demographics
NPI:1922560044
Name:DIET TO LIFESTYLE LLC
Entity Type:Organization
Organization Name:DIET TO LIFESTYLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAMURA
Authorized Official - Middle Name:ALYN
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:304-437-3031
Mailing Address - Street 1:5863 EL SEGUNDO WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-732-4010
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4861
Practice Address - Country:US
Practice Address - Phone:706-431-5757
Practice Address - Fax:866-732-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty