Healthcare Provider Details

I. General information

NPI: 1770221194
Provider Name (Legal Business Name): GEORGETA BARBU NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15636 RICHMOND ST
SOUTHGATE MI
48195-3452
US

IV. Provider business mailing address

15636 RICHMOND ST
SOUTHGATE MI
48195-3452
US

V. Phone/Fax

Practice location:
  • Phone: 586-646-0458
  • Fax:
Mailing address:
  • Phone: 586-646-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1210655728
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: