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General NPI Number Information
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NPI Number | 1316564909
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Entity Type | Organization
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Legal Business Name | KIDNEY NUTRITION SPECIALIST LLC
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 1425 HIGHWAY 34 E
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City | NEWNAN
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State | GA
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Zip | 30265-1323
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Country | US
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Telephone | 470-205-0119
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Fax | 770-580-1880
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Provider Business Mailing Address
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Address Line | 213 HIGHLAND HILLS RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-5429
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Country | US
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Telephone | 770-568-0162
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JADEDA DARWASHIA HOOKS
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Credential | RDN
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Telephone | 770-568-0162
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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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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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