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NPI Code Detail

MEDICARE: MS. SARA ROSE ADDISON MS, RD, LD

MEDICARE: MS. SARA ROSE ADDISON MS, RD, LD
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
1133V00000XRegistered DietitianLD003685GA

General Provider Information

NPI Number : 1073139994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SARA ROSE ADDISON MS, RD, LD
Provider Business Mailing Address
First Line : 601 DALLAS HWY
Second Line :
City : VILLA RICA
State : GA
Zip : 30180-1202
Country : US
Telephone Number : 770-812-3249
Fax Number :
Provider Business Practice Location Address
First Line : 601 DALLAS HWY
Second Line :
City : VILLA RICA
State : GA
Zip : 30180-1202
Country : US
Telephone Number : 770-812-3249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2020
Last Update Date : 06/17/2020

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