Healthcare Provider Details

I. General information

NPI: 1164838173
Provider Name (Legal Business Name): SALLY BUTLER STIEGHAN R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 14TH ST NE APT 213
ATLANTA GA
30309-7681
US

IV. Provider business mailing address

222 14TH ST NE APT 213
ATLANTA GA
30309-7681
US

V. Phone/Fax

Practice location:
  • Phone: 706-392-0411
  • Fax:
Mailing address:
  • Phone: 706-392-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD002495
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: