Healthcare Provider Details

I. General information

NPI: 1780018044
Provider Name (Legal Business Name): MOLLY HAND RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ROSS CLARK CIR
DOTHAN AL
36301
US

IV. Provider business mailing address

1108 ROSS CLARK CIR
DOTHAN AL
36301-3022
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-8854
  • Fax: 334-712-3704
Mailing address:
  • Phone: 334-793-8854
  • Fax: 334-712-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2277
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: