MEDICARE: CHRISTINA ELLENBERG RD, LDN, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L008727	NC
2	133V00000X	Registered Dietitian	LD004769	GA

General Provider Information

NPI Number	:	1265970925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ELLENBERG RD, LDN, CSCS

Provider Business Mailing Address
First Line	:	2692 GALAHAD DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3627
Country	:	US
Telephone Number	:	704-351-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 GALAHAD DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3627
Country	:	US
Telephone Number	:	704-351-1552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	07/24/2025

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