Healthcare Provider Details

I. General information

NPI: 1841952546
Provider Name (Legal Business Name): OLIVIA BUBRI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 GLENDALE TER NE UNIT 8
ATLANTA GA
30309-4255
US

IV. Provider business mailing address

890 GLENDALE TER NE UNIT 8
ATLANTA GA
30309-4255
US

V. Phone/Fax

Practice location:
  • Phone: 239-293-7384
  • Fax:
Mailing address:
  • Phone: 239-293-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: