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General NPI Number Information
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NPI Number | 1093521411
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Entity Type | Organization
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Legal Business Name | EAT WELL LIVE WELL, LLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 467 HIDDEN OAKS DR
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City | FLINTSTONE
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State | GA
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Zip | 30725-2746
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Country | US
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Telephone | 907-290-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 467 HIDDEN OAKS DR
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City | FLINTSTONE
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State | GA
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Zip | 30725-2746
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Country | US
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Telephone | 907-290-1635
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Fax |
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Authorized Official
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Title or Position | OWNER/REGISTERED DIETITIAN
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Name | DANIELLE CRUMBLE SMITH
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Credential |
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Telephone | 907-290-1635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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