Provider Demographics
NPI:1811747504
Name:SCHMIT, KIAH (NDTR)
Entity type:Individual
Prefix:
First Name:KIAH
Middle Name:
Last Name:SCHMIT
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DOOLITTLE CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2563
Mailing Address - Country:US
Mailing Address - Phone:612-518-0952
Mailing Address - Fax:
Practice Address - Street 1:27 DOOLITTLE CT
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2563
Practice Address - Country:US
Practice Address - Phone:612-518-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
GA136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist