Healthcare Provider Details

I. General information

NPI: 1316829641
Provider Name (Legal Business Name): TAMMY L. BOGDAN MS, RD, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 WOLF CLAW CT
MARIETTA GA
30062-1369
US

IV. Provider business mailing address

3211 WOLF CLAW CT
MARIETTA GA
30062-1369
US

V. Phone/Fax

Practice location:
  • Phone: 678-485-6816
  • Fax: 404-393-1539
Mailing address:
  • Phone: 678-485-6816
  • Fax: 404-393-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD002311
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD002311
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD002311
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: