Provider Demographics
NPI:1508611468
Name:IMMORTAL ATHLETICS LLC
Entity type:Organization
Organization Name:IMMORTAL ATHLETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEJN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:704-616-8574
Mailing Address - Street 1:235A MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032-1146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235A MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAMERTON
Practice Address - State:NC
Practice Address - Zip Code:28032-1146
Practice Address - Country:US
Practice Address - Phone:704-879-5693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty