Healthcare Provider Details

I. General information

NPI: 1700204526
Provider Name (Legal Business Name): ADVANCED NUTRITION CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4547 SABIN ST
ROCK HILL SC
29732-8363
US

IV. Provider business mailing address

4547 SABIN ST
ROCK HILL SC
29732-8363
US

V. Phone/Fax

Practice location:
  • Phone: 803-280-8002
  • Fax:
Mailing address:
  • Phone: 803-280-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number611
License Number StateSC

VIII. Authorized Official

Name: SARAH ATKINSON
Title or Position: PRESIDANT
Credential: RD, CSR, LD
Phone: 803-280-8002