MEDICARE: B FIT 4 LIFE, INC

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	133NN1002X	Nutrition Education Nutritionist
2	207R00000X	Internal Medicine Physician	036409	GA

General Provider Information

NPI Number	:	1730315235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B FIT 4 LIFE, INC

Provider Business Mailing Address
First Line	:	6825 JIMMY CARTER BLVD
Second Line	:	1800
City	:	NORCROSS
State	:	GA
Zip	:	30071
Country	:	US
Telephone Number	:	404-496-4386
Fax Number	:	404-963-0503

Provider Business Practice Location Address
First Line	:	6825 JIMMY CARTER BLVD
Second Line	:	SUITE1800
City	:	NORCROSS
State	:	GA
Zip	:	30071-1228
Country	:	US
Telephone Number	:	404-496-4386
Fax Number	:	404-963-0503

Authorized Official
Title or Position	:	CEO
Name	:	BETTY KITCHEN
Credential	:	PHD
Telephone Number	:	404-496-4386

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/10/2009

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