Healthcare Provider Details

I. General information

NPI: 1851057251
Provider Name (Legal Business Name): ALISA MEYER LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 LAUREL SUMMIT DR SE
SMYRNA GA
30082-4331
US

IV. Provider business mailing address

1253 LAUREL SUMMIT DR SE
SMYRNA GA
30082-4331
US

V. Phone/Fax

Practice location:
  • Phone: 704-785-4197
  • Fax:
Mailing address:
  • Phone: 704-785-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD-P000290
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: