MEDICARE: CHANDRA BIVENS CARTY R.D.,L.D.

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	LD000618	GA
2	133VN1004X	Pediatric Nutrition Registered Dietitian	LD000618	GA
3	133VN1005X	Renal Nutrition Registered Dietitian	LD000618	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841395068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA BIVENS CARTY R.D.,L.D.

Provider Business Mailing Address
First Line	:	2605 BRUSHY NOB LN
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5243
Country	:	US
Telephone Number	:	770-389-0836
Fax Number	:	770-389-0886

Provider Business Practice Location Address
First Line	:	1516 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	770-389-0836
Fax Number	:	770-389-0886

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	11/04/2011

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