Provider Demographics
NPI:1356907018
Name:FAMILY NUTRITION SOLUTIONS, LLC
Entity type:Organization
Organization Name:FAMILY NUTRITION SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:470-394-2868
Mailing Address - Street 1:2483 HERITAGE VLG STE 16149
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6140
Mailing Address - Country:US
Mailing Address - Phone:470-394-2868
Mailing Address - Fax:
Practice Address - Street 1:1755 SKYLAND GLEN DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3869
Practice Address - Country:US
Practice Address - Phone:470-394-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811478472Medicaid