Healthcare Provider Details

I. General information

NPI: 1740521848
Provider Name (Legal Business Name): TRACY KUZAVA MBA, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 MCGEE RD
SNELLVILLE GA
30078-2910
US

IV. Provider business mailing address

2529 GREENFIELD LN
MONROE GA
30655-6298
US

V. Phone/Fax

Practice location:
  • Phone: 678-884-9317
  • Fax:
Mailing address:
  • Phone: 678-787-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003785
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: