Healthcare Provider Details

I. General information

NPI: 1093199622
Provider Name (Legal Business Name): MERCY AREMU RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date: 06/26/2020
Reactivation Date: 08/10/2022

III. Provider practice location address

2330 SCENIC HWY S STE 203
SNELLVILLE GA
30078-3115
US

IV. Provider business mailing address

PO BOX 3021
LOGANVILLE GA
30052-1968
US

V. Phone/Fax

Practice location:
  • Phone: 770-881-8651
  • Fax:
Mailing address:
  • Phone: 704-691-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004135
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: