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General NPI Number Information
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NPI Number | 1801567045
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Entity Type | Organization
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Legal Business Name | FEEDING THE ROOT, LLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 2959 ELMORE PARK RD STE 8
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City | BARTLETT
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State | TN
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Zip | 38134-8379
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Country | US
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Telephone | 662-912-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 2959 ELMORE PARK RD STE 8
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City | BARTLETT
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State | TN
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Zip | 38134-8379
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Country | US
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Telephone | 662-912-4090
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | SAMARIA DONIELLE GRANDBERRY
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Credential |
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Telephone | 901-351-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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