Healthcare Provider Details

I. General information

NPI: 1619095098
Provider Name (Legal Business Name): CITY OF GAINESVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 PRIOR ST SE
GAINESVILLE GA
30501-3402
US

IV. Provider business mailing address

430 PRIOR ST SE
GAINESVILLE GA
30501-3402
US

V. Phone/Fax

Practice location:
  • Phone: 770-503-3330
  • Fax: 770-503-3344
Mailing address:
  • Phone: 770-503-3330
  • Fax: 770-503-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number133NN1002X
License Number StateGA

VIII. Authorized Official

Name: MRS. RHONDA PITTMAN
Title or Position: ADMINISTRATIVE SECRETARY
Credential:
Phone: 770-503-3334