Healthcare Provider Details

I. General information

NPI: 1548387830
Provider Name (Legal Business Name): GEETHA NATARAJAN RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 10TH ST DEPARTMENT OF HEALTH
COOKEVILLE TN
38501-6077
US

IV. Provider business mailing address

2149 WILLIAMSBURG CIR
COOKEVILLE TN
38506-3401
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-7531
  • Fax: 931-520-0413
Mailing address:
  • Phone: 931-432-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000000412
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: