Provider Demographics
NPI:1649727140
Name:ANNIE GOLDSMITH RD
Entity type:Organization
Organization Name:ANNIE GOLDSMITH RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:980-368-2734
Mailing Address - Street 1:PO BOX 11141
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2214
Mailing Address - Country:US
Mailing Address - Phone:980-368-2734
Mailing Address - Fax:
Practice Address - Street 1:1110 SAM NEWELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5013
Practice Address - Country:US
Practice Address - Phone:980-368-2734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty