Provider Demographics
NPI:1134368525
Name:LESTER HOLDER, MELANIE PATRICE (RD, LD, CLC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:PATRICE
Last Name:LESTER HOLDER
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 N EXPRESSWAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-2095
Mailing Address - Country:US
Mailing Address - Phone:678-250-6489
Mailing Address - Fax:
Practice Address - Street 1:426 N EXPRESSWAY UNIT 3
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2095
Practice Address - Country:US
Practice Address - Phone:678-250-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered