Provider Demographics
NPI:1649543877
Name:DICKEY, RAYLENTINA LATOYA (RD, LD)
Entity type:Individual
Prefix:MISS
First Name:RAYLENTINA
Middle Name:LATOYA
Last Name:DICKEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10104 DEEP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1098
Mailing Address - Country:US
Mailing Address - Phone:404-788-5217
Mailing Address - Fax:
Practice Address - Street 1:10104 DEEP CREEK DR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1098
Practice Address - Country:US
Practice Address - Phone:404-788-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007163133V00000X
MDDX6105133V00000X
GALD003485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered