Healthcare Provider Details

I. General information

NPI: 1740988997
Provider Name (Legal Business Name): OUTREACH FOR NUTRITION EDUCATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 ROGERS BRIDGED ROAD SUITE #304 B
DULUTH GA
30097-2809
US

IV. Provider business mailing address

5210 HARBURY LN
SUWANEE GA
30024-7541
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-9292
  • Fax: 678-954-2554
Mailing address:
  • Phone: 678-687-9292
  • Fax: 678-954-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: BEENA DESHPANDE
Title or Position: CEO
Credential: REGISTERED DIETITIAN
Phone: 678-687-9292