Provider Demographics
NPI:1700183407
Name:SINGLE PARENTS NIA
Entity type:Organization
Organization Name:SINGLE PARENTS NIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITIONIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORRESTER-THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-507-2555
Mailing Address - Street 1:4822 N HENRY BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3556
Mailing Address - Country:US
Mailing Address - Phone:770-507-2555
Mailing Address - Fax:
Practice Address - Street 1:4822 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3556
Practice Address - Country:US
Practice Address - Phone:770-507-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service