Healthcare Provider Details

I. General information

NPI: 1548940828
Provider Name (Legal Business Name): FLT FAMILY NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EVENING PINE LN
JOHNS CREEK GA
30005-7417
US

IV. Provider business mailing address

660 EVENING PINE LN
JOHNS CREEK GA
30005-7417
US

V. Phone/Fax

Practice location:
  • Phone: 770-380-2160
  • Fax:
Mailing address:
  • Phone: 770-380-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: FLORENCIA TARASIDO
Title or Position: REGISTERED DIETITIAN
Credential: RD, IBCLC
Phone: 770-380-2160