Healthcare Provider Details

I. General information

NPI: 1417346941
Provider Name (Legal Business Name): RACHEL MARYNOWSKI ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BOULEVARD NE SUITE 110
ATLANTA GA
30312-4205
US

IV. Provider business mailing address

285 BOULEVARD NE SUITE 110
ATLANTA GA
30312-4205
US

V. Phone/Fax

Practice location:
  • Phone: 404-424-8777
  • Fax:
Mailing address:
  • Phone: 404-424-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number099.0071910
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: