Provider Demographics
NPI:1770058745
Name:MILLER, CHRISTEN SIMONE (RD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTEN
Middle Name:SIMONE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 RAVEN ROCK TRL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7690
Mailing Address - Country:US
Mailing Address - Phone:770-714-5155
Mailing Address - Fax:
Practice Address - Street 1:1395 RAVEN ROCK TRL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7690
Practice Address - Country:US
Practice Address - Phone:770-714-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty