Healthcare Provider Details

I. General information

NPI: 1063171866
Provider Name (Legal Business Name): VIRGINIA LADNER MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD BLDG 9250
FORT MOORE GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD BLDG 9250
FORT MOORE GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 404-561-5456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003697
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: