Healthcare Provider Details

I. General information

NPI: 1184158016
Provider Name (Legal Business Name): FLAVIA SOUZA R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MCCLURE BRIDGE RD
DULUTH GA
30096-3223
US

IV. Provider business mailing address

2576 KENWOOD DR
DULUTH GA
30096-3636
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-6042
  • Fax:
Mailing address:
  • Phone: 940-206-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: