Healthcare Provider Details

I. General information

NPI: 1225867708
Provider Name (Legal Business Name): KATHRYN GAZAWAY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 WALTHOUR RD
SAVANNAH GA
31410-3218
US

IV. Provider business mailing address

2973 HEART PINE LN
BUFORD GA
30519-7643
US

V. Phone/Fax

Practice location:
  • Phone: 678-995-2838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD006546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: