Provider Demographics
NPI:1942934062
Name:GRANATO, KERIANN COMBS (RD, LD)
Entity Type:Individual
Prefix:
First Name:KERIANN
Middle Name:COMBS
Last Name:GRANATO
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 1:447 N HIGHLAND AVE NE APT 19
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1459
Mailing Address - Country:US
Mailing Address - Phone:615-491-5151
Mailing Address - Fax:
Practice Address - Street 1:447 N HIGHLAND AVE NE APT 19
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1459
Practice Address - Country:US
Practice Address - Phone:615-491-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005598133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered