Provider Demographics
NPI:1962020735
Name:YATES, KELLI ROSE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ROSE
Last Name:YATES
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 CHIMNEY SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5730
Mailing Address - Country:US
Mailing Address - Phone:678-643-9558
Mailing Address - Fax:
Practice Address - Street 1:4472 CHIMNEY SPRINGS CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5730
Practice Address - Country:US
Practice Address - Phone:678-643-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered