Provider Demographics
NPI:1649003765
Name:SUSTAINWELL NASHVILLE
Entity type:Organization
Organization Name:SUSTAINWELL NASHVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:850-520-2182
Mailing Address - Street 1:515 MADISON ST APT 15
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1661
Mailing Address - Country:US
Mailing Address - Phone:850-520-2182
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON ST APT 15
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-1661
Practice Address - Country:US
Practice Address - Phone:850-520-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty