Healthcare Provider Details

I. General information

NPI: 1831278183
Provider Name (Legal Business Name): CYNTHIA F CATTS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3814
US

IV. Provider business mailing address

5160 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3814
US

V. Phone/Fax

Practice location:
  • Phone: 803-642-9360
  • Fax: 803-642-9361
Mailing address:
  • Phone: 803-642-9360
  • Fax: 803-642-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number649579
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: