Provider Demographics
NPI:1881944213
Name:DITTMER, CALA ELKINS (RD)
Entity type:Individual
Prefix:
First Name:CALA
Middle Name:ELKINS
Last Name:DITTMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CALA
Other - Middle Name:LYNN
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-378-8189
Practice Address - Fax:706-238-8037
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128800AMedicaid
GA003128800BMedicaid
GA003128800EMedicaid
GA003128800EMedicaid