MEDICARE: NUTRITION DIRECTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD002518	GA

General Provider Information

NPI Number	:	1023461787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION DIRECTIONS, LLC

Provider Business Mailing Address
First Line	:	4739 RUBY FORREST DR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-4942
Country	:	US
Telephone Number	:	404-277-8754
Fax Number	:

Provider Business Practice Location Address
First Line	:	4739 RUBY FORREST DR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-4942
Country	:	US
Telephone Number	:	404-277-8754
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. MAGON SAUNDERS
Credential	:	DHSC, MS, RDN, LS
Telephone Number	:	404-277-8754

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “NUTRITION DIRECTIONS, LLC ” Practice Location

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