Provider Demographics
NPI:1669089215
Name:G & G NUTRITION CO. LLC
Entity type:Organization
Organization Name:G & G NUTRITION CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:540-798-9063
Mailing Address - Street 1:2820 SELWYN AVE STE 745
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2765
Mailing Address - Country:US
Mailing Address - Phone:980-349-7763
Mailing Address - Fax:980-422-0081
Practice Address - Street 1:2820 SELWYN AVE STE 745
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2765
Practice Address - Country:US
Practice Address - Phone:980-349-7763
Practice Address - Fax:980-422-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty