Provider Demographics
NPI:1134196066
Name:VERGIS, LOIS (MS, RD,LD, CDE)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:VERGIS
Suffix:
Gender:F
Credentials:MS, RD,LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CROFTMOORE LNDG
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6924
Mailing Address - Country:US
Mailing Address - Phone:678-442-4117
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7636
Practice Address - Country:US
Practice Address - Phone:678-442-4117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered