Healthcare Provider Details

I. General information

NPI: 1538859681
Provider Name (Legal Business Name): ADDIE LAFOREST BROOKS MSHA, RDN, CSO, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADDIE LAFOREST ACKERSON

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FY RD NE STE 335
ATLANTA GA
30342-1625
US

IV. Provider business mailing address

992 HAWTHORNE WAY
MARIETTA GA
30062-3115
US

V. Phone/Fax

Practice location:
  • Phone: 404-497-8700
  • Fax: 404-497-8701
Mailing address:
  • Phone: 404-293-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: