Healthcare Provider Details

I. General information

NPI: 1629992250
Provider Name (Legal Business Name): TASTY FOOD BOWL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4958 ZOYA CT SW
ATLANTA GA
30331-7528
US

IV. Provider business mailing address

4958 ZOYA CT SW
ATLANTA GA
30331-7528
US

V. Phone/Fax

Practice location:
  • Phone: 470-479-1301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: KANDICE S STANDIFER
Title or Position: OWNER
Credential:
Phone: 470-479-1301