Healthcare Provider Details

I. General information

NPI: 1669630778
Provider Name (Legal Business Name): REGINA MARIE SAXTON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA MERRELL RD, LD

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 THOMPSON BRIDGE RD STE 111
GAINESVILLE GA
30501
US

IV. Provider business mailing address

PO BOX 3142
SUWANEE GA
30024-0988
US

V. Phone/Fax

Practice location:
  • Phone: 678-372-2346
  • Fax: 833-293-2482
Mailing address:
  • Phone: 678-372-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: