Healthcare Provider Details

I. General information

NPI: 1376579656
Provider Name (Legal Business Name): MELISSA ANN KRENTZMAN MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 BARFIELD RUN NW
ATLANTA GA
30318-2778
US

IV. Provider business mailing address

1685 BARFIELD RUN NW
ATLANTA GA
30318-2778
US

V. Phone/Fax

Practice location:
  • Phone: 404-293-0502
  • Fax:
Mailing address:
  • Phone: 404-293-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD002779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: