Healthcare Provider Details

I. General information

NPI: 1366755704
Provider Name (Legal Business Name): JULIE E AITCHISON M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 BAKER ST NE SUITE 100
COVINGTON GA
30014-1405
US

IV. Provider business mailing address

4155 BAKER ST NE SUITE 100
COVINGTON GA
30014-1405
US

V. Phone/Fax

Practice location:
  • Phone: 770-788-0620
  • Fax:
Mailing address:
  • Phone: 770-788-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: