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General NPI Number Information
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NPI Number | 1508859992
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Entity Type | Individual
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Provider Name | JESSICA GREER ZOMBEK RD, LD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1004 NEWNAN RD
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City | CARROLLTON
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State | GA
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Zip | 30116-6428
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Country | US
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Telephone | 770-836-6667
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 LAKEVIEW PKWY
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City | VILLA RICA
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State | GA
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Zip | 30180-7802
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Country | US
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Telephone | 770-783-0031
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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 | LD002841
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License Number State | GA
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