Provider Demographics
NPI:1740304823
Name:BELL, LYNN RAE (PRD, RD, LD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:RAE
Last Name:BELL
Suffix:
Gender:F
Credentials:PRD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 KILARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-0815
Mailing Address - Country:US
Mailing Address - Phone:229-242-2800
Mailing Address - Fax:
Practice Address - Street 1:206 S PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5668
Practice Address - Country:US
Practice Address - Phone:229-245-2301
Practice Address - Fax:229-245-2341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001243133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic