MEDICARE: DR. ELIZABETH HOLLY REDMOND PHD, RDN

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	LD001167	GA

General Provider Information

NPI Number	:	1669035234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH HOLLY REDMOND PHD, RDN

Provider Business Mailing Address
First Line	:	2312 SPRING CREEK RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2743
Country	:	US
Telephone Number	:	404-394-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 W PEACHTREE ST STE 2312
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3449
Country	:	US
Telephone Number	:	404-394-5997
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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