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General NPI Number Information
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NPI Number | 1639573447
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Entity Type | Organization
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Legal Business Name | CORE DIABETES
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 7921 LONG DRIVE
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-598-0170
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Fax |
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Provider Business Mailing Address
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Address Line | 7921 LONG DRIVE
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNY MADZIN
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Credential | MS, RD, CDE, LDN
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Telephone | 423-598-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 844622
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 844622
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License Number State | TN
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