Provider Demographics
NPI:1134371586
Name:LESSIG, GELSIE F (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:GELSIE
Middle Name:F
Last Name:LESSIG
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 1:6145 POLO CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5714
Mailing Address - Country:US
Mailing Address - Phone:678-717-8951
Mailing Address - Fax:770-392-9831
Practice Address - Street 1:6145 POLO CLUB DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-5714
Practice Address - Country:US
Practice Address - Phone:678-717-8951
Practice Address - Fax:770-392-9831
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD0005326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered