Healthcare Provider Details

I. General information

NPI: 1205553443
Provider Name (Legal Business Name): MICHELLE GIANG MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245 BLDG 3031
APO AP
96271
US

IV. Provider business mailing address

4500 BRADSTONE TRCE NW
LILBURN GA
30047-8018
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2019
  • Fax:
Mailing address:
  • Phone: 404-271-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: