Provider Demographics
NPI:1700116720
Name:TAYLOR, HEIDI NICOLE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:NICOLE
Last Name:TAYLOR
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 1:1101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3525
Mailing Address - Country:US
Mailing Address - Phone:912-287-4863
Mailing Address - Fax:912-287-5875
Practice Address - Street 1:101 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2540
Practice Address - Country:US
Practice Address - Phone:912-287-4863
Practice Address - Fax:912-287-5875
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered