Provider Demographics
NPI:1649886185
Name:HANCE, EMILY (DTR)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HANCE
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 AMALIE FARMS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8588
Mailing Address - Country:US
Mailing Address - Phone:404-483-4247
Mailing Address - Fax:
Practice Address - Street 1:424 AMALIE FARMS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8588
Practice Address - Country:US
Practice Address - Phone:404-483-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86172534136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered