Provider Demographics
NPI:1982161469
Name:CARNEY, RECBECCA ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:RECBECCA
Middle Name:ANN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:VANDERSLIVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4200 NORTHSIDE PKWY NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3007
Mailing Address - Country:US
Mailing Address - Phone:770-881-8020
Mailing Address - Fax:877-787-7051
Practice Address - Street 1:4200 NORTHSIDE PKWY NW STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3007
Practice Address - Country:US
Practice Address - Phone:770-881-8020
Practice Address - Fax:877-787-7051
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD004803OtherSTATE LICENSE
GA133V00000XOtherTAXONOMY