Healthcare Provider Details

I. General information

NPI: 1326479262
Provider Name (Legal Business Name): LORI ANN SCHOLLE MS, RDN, LD, CBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PONCE DE LEON PL
DECATUR GA
30030-5108
US

IV. Provider business mailing address

PO BOX 1623
DECATUR GA
30031-1623
US

V. Phone/Fax

Practice location:
  • Phone: 404-566-4538
  • Fax: 404-566-4539
Mailing address:
  • Phone: 404-566-4538
  • Fax: 404-566-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004058
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD004058
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberLD004058
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: