Healthcare Provider Details

I. General information

NPI: 1003291766
Provider Name (Legal Business Name): KATHERINE FOLEY MS RD LD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 MOUNT ZION PKWY
JONESBORO GA
30236-2500
US

IV. Provider business mailing address

2470 MOUNT ZION PKWY
JONESBORO GA
30236-2500
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-3978
  • Fax:
Mailing address:
  • Phone: 770-603-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number885872
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: