Provider Demographics
NPI:1184007494
Name:SCHRIVER, KELLY (MS RDN LD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCHRIVER
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 MARSHALLS CV
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8203
Mailing Address - Country:US
Mailing Address - Phone:404-915-8776
Mailing Address - Fax:404-549-4644
Practice Address - Street 1:355 MARSHALLS CV
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-8203
Practice Address - Country:US
Practice Address - Phone:404-915-8776
Practice Address - Fax:404-549-4644
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered