Provider Demographics
NPI:1134448640
Name:FORRESTER-THORNE, EILEEN A
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:A
Last Name:FORRESTER-THORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 GOSSAMERE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7007
Mailing Address - Country:US
Mailing Address - Phone:757-582-4361
Mailing Address - Fax:770-507-2542
Practice Address - Street 1:1023 GOSSAMERE WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7007
Practice Address - Country:US
Practice Address - Phone:757-582-4361
Practice Address - Fax:770-507-2542
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education