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General NPI Number Information
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NPI Number | 1326993791
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Entity Type | Organization
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Legal Business Name | MANIFEST NUTRITION LLC
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 44 DARBYS CROSSING DR STE 206
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City | HIRAM
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State | GA
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Zip | 30141-6008
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Country | US
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Telephone | 470-954-6517
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PROSPECT PATH
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City | HIRAM
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State | GA
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Zip | 30141-2694
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Country | US
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Telephone | 470-954-6517
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Fax |
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Authorized Official
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Title or Position | RDN/OWNER
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Name | KEIRRA CROMER-ELLIS
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Credential | RDN
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Telephone | 470-954-6517
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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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