Healthcare Provider Details

I. General information

NPI: 1982595450
Provider Name (Legal Business Name): IZABELE SCOVIL RD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOODRUFF CIR SUITE 7130
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

1659 MONROE DR NE APT W9
ATLANTA GA
30324-2806
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-7317
  • Fax:
Mailing address:
  • Phone: 520-609-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: