Healthcare Provider Details

I. General information

NPI: 1245861459
Provider Name (Legal Business Name): REBEKAH LAURANCE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 PAULSEN ST STE 105
SAVANNAH GA
31405-4424
US

IV. Provider business mailing address

8000 WATERS AVE APT 199
SAVANNAH GA
31406-4985
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-3944
  • Fax: 912-819-3943
Mailing address:
  • Phone: 205-552-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD005505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: