Provider Demographics
NPI:1881776730
Name:SOUTHERN DIETETICS, INC.
Entity type:Organization
Organization Name:SOUTHERN DIETETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BLUMER
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:850-832-4196
Mailing Address - Street 1:2818 LONGLEAF RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2000
Mailing Address - Country:US
Mailing Address - Phone:850-832-4196
Mailing Address - Fax:850-763-2583
Practice Address - Street 1:2818 LONGLEAF RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2000
Practice Address - Country:US
Practice Address - Phone:850-832-4196
Practice Address - Fax:850-763-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND0001140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty