Healthcare Provider Details

I. General information

NPI: 1457996456
Provider Name (Legal Business Name): ELIZABETH BENEFIELD BATTLE RDN,CSO,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ARLENE BENEFIELD RDN, LD

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE D250
ATLANTA GA
30342-1646
US

IV. Provider business mailing address

3275 RIVERHILL CT
CUMMING GA
30041-2804
US

V. Phone/Fax

Practice location:
  • Phone: 404-236-8036
  • Fax: 404-236-8051
Mailing address:
  • Phone: 334-791-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberLD004433
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: