Provider Demographics
NPI:1336521855
Name:MUELLER, CAROLYN SUZANNE (MS, RDN, LD, CDE)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUZANNE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS, RDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 CATES AVE NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2308
Mailing Address - Country:US
Mailing Address - Phone:270-991-4244
Mailing Address - Fax:678-973-2984
Practice Address - Street 1:3242 CATES AVE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2308
Practice Address - Country:US
Practice Address - Phone:270-991-4244
Practice Address - Fax:678-973-2984
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered