Healthcare Provider Details

I. General information

NPI: 1235446758
Provider Name (Legal Business Name): LENA DANIELLE BEAL MS., RD., LD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

4343 RAINER DR
ATLANTA GA
30349-3993
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-3167
  • Fax: 404-367-3580
Mailing address:
  • Phone: 678-480-5754
  • Fax: 866-616-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD002226
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002226
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD002226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: