Provider Demographics
NPI:1336866532
Name:SOPHIE DOLAN NUTRITION, LLC
Entity Type:Organization
Organization Name:SOPHIE DOLAN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:205-532-5990
Mailing Address - Street 1:2900 CAHABA RD STE 100O
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1937
Mailing Address - Country:US
Mailing Address - Phone:205-532-5990
Mailing Address - Fax:
Practice Address - Street 1:2900 CAHABA RD STE 100O
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-1937
Practice Address - Country:US
Practice Address - Phone:205-259-6710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty