MEDICARE: JADEDA DARWASHIA HOOKS RD

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	LD003784	GA

General Provider Information

NPI Number	:	1174834493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADEDA DARWASHIA HOOKS RD

Provider Business Mailing Address
First Line	:	213 HIGHLAND HILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-5429
Country	:	US
Telephone Number	:	770-568-0162
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 HIGHLAND HILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-5429
Country	:	US
Telephone Number	:	770-568-0162
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/13/2020

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