Healthcare Provider Details

I. General information

NPI: 1215294988
Provider Name (Legal Business Name): THORNTON DIETITIAN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SANDSTONE CIR SUITE E
JACKSON TN
38305-2098
US

IV. Provider business mailing address

36 SANDSTONE CIR SUITE E
JACKSON TN
38305-2098
US

V. Phone/Fax

Practice location:
  • Phone: 731-676-0793
  • Fax:
Mailing address:
  • Phone: 731-676-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1348
License Number StateTN

VIII. Authorized Official

Name: MRS. SHARON BLACKWELL THORNTON
Title or Position: REGISTERED DIETITIAN
Credential: R.D.
Phone: 731-676-0793