Provider Demographics
NPI:1790296804
Name:LIVING RENEWED, INC.
Entity type:Organization
Organization Name:LIVING RENEWED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD, IFNCP
Authorized Official - Phone:770-744-1995
Mailing Address - Street 1:PO BOX 1715
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-8715
Mailing Address - Country:US
Mailing Address - Phone:770-744-1995
Mailing Address - Fax:
Practice Address - Street 1:1862 AUBURN RD STE 118-Q5
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1676
Practice Address - Country:US
Practice Address - Phone:770-744-1995
Practice Address - Fax:770-766-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty