MEDICARE: CANDACE COATS LOWE

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	003238	GA

General Provider Information

NPI Number	:	1326547886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE COATS LOWE

Provider Business Mailing Address
First Line	:	1525 LAUREL CROSSING PKWY APT 811
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-6581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 LAUREL CROSSING PKWY APT 811
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-6581
Country	:	US
Telephone Number	:	706-342-6795
Fax Number	:

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	02/09/2018

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Directions to “ CANDACE COATS LOWE ” Practice Location

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