Provider Demographics
NPI:1841062585
Name:LAMPA, MILLICENT (RD)
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:
Last Name:LAMPA
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 1:703 VAN BRIGGLE PATH
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7126
Mailing Address - Country:US
Mailing Address - Phone:770-843-5713
Mailing Address - Fax:
Practice Address - Street 1:703 VAN BRIGGLE PATH
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7126
Practice Address - Country:US
Practice Address - Phone:770-843-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004531133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal