Healthcare Provider Details

I. General information

NPI: 1114329158
Provider Name (Legal Business Name): JAMIE LEIGH MARTIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR NUTRITION AND FOOD SERVICES
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR NUTRITION AND FOOD SERVICES
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3772
  • Fax: 919-966-3217
Mailing address:
  • Phone: 919-966-3772
  • Fax: 919-966-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL004038
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004038
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: