Healthcare Provider Details

I. General information

NPI: 1427573542
Provider Name (Legal Business Name): MEGAN RENEE RIPPERGER MS, RD, CSSD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN RENEE KWON MS, RD, CSSD, LD

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD
FORT MOORE GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD
FORT MOORE GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-2273
  • Fax:
Mailing address:
  • Phone: 627-408-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberLD004915
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004915
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: