MEDICARE: ATLANTA MACKLIN RDN, 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
1	133V00000X	Registered Dietitian	DT86780	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DT86780	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1083207948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATLANTA MACKLIN RDN, LD

Provider Business Mailing Address
First Line	:	743 CAMBRIDGE DR
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4333
Country	:	US
Telephone Number	:	210-439-1714
Fax Number	:	830-730-5652

Provider Business Practice Location Address
First Line	:	2115 STEPHENS PL STE 400B
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-2167
Country	:	US
Telephone Number	:	210-439-1714
Fax Number	:	830-730-5652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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