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General NPI Number Information
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NPI Number | 1497169189
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Entity Type | Individual
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Provider Name | KRISTIN DUGGER CUCULOVSKI RDN
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Gender | Female
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 2030 POWERS FERRY RD SE STE 325
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City | ATLANTA
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State | GA
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Zip | 30339-5065
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Country | US
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Telephone | 404-987-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 993 JOHNSON FY RD NE STE D250
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City | ATLANTA
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State | GA
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Zip | 30342-1646
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Country | US
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Telephone | 404-236-8028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LD004247
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number | 4247
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License Number State | GA
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