Healthcare Provider Details

I. General information

NPI: 1033230719
Provider Name (Legal Business Name): CYNTHIA LUTTERBIE RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 JOHNSON FERRY RD NE
ATLANTA GA
30328-4128
US

IV. Provider business mailing address

4252 PLANTATION TRACE DR
DULUTH GA
30096-6326
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-6161
  • Fax: 404-257-2184
Mailing address:
  • Phone: 404-303-6161
  • Fax: 404-257-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002714
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: