Provider Demographics
NPI:1962018283
Name:LAST, ALYSON (RD, LD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:LAST
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:SHEWBART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5601 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9001
Mailing Address - Country:US
Mailing Address - Phone:706-530-4339
Mailing Address - Fax:
Practice Address - Street 1:5601 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9001
Practice Address - Country:US
Practice Address - Phone:706-530-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered