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General NPI Number Information
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NPI Number | 1881024636
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Entity Type | Organization
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Legal Business Name | GREEN APPLE NUTRITION, INC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 5755 N POINT PKWY SUITE 64
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City | ALPHARETTA
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State | GA
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Zip | 30022-1142
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Country | US
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Telephone | 678-965-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 8685 VALDERAMA DR
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City | DULUTH
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State | GA
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Zip | 30097-6649
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Country | US
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Telephone | 678-749-8634
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | NILAM GANGWAL
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Credential | MS, RD, LD
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Telephone | 678-749-8634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | LD003621
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License Number State | GA
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