Provider Demographics
NPI:1740654656
Name:THIRD ENDEAVOR LLC
Entity type:Organization
Organization Name:THIRD ENDEAVOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEE-DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:404-435-8375
Mailing Address - Street 1:17 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1537
Mailing Address - Country:US
Mailing Address - Phone:404-435-8375
Mailing Address - Fax:
Practice Address - Street 1:17 HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1537
Practice Address - Country:US
Practice Address - Phone:404-435-8375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty