Healthcare Provider Details

I. General information

NPI: 1073426854
Provider Name (Legal Business Name): SOUTHEASTERN DIETETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23858 US HIGHWAY 98 STE F
FAIRHOPE AL
36532-3480
US

IV. Provider business mailing address

23858 US HIGHWAY 98 STE F
FAIRHOPE AL
36532-3480
US

V. Phone/Fax

Practice location:
  • Phone: 251-421-0814
  • Fax:
Mailing address:
  • Phone: 251-421-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: STEVEN THRASHER
Title or Position: OWNER
Credential: MS, RDN, LD
Phone: 251-421-0814