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NPI Code Detail

MEDICARE: MARY ELIZABETH WHELAN RD

MEDICARE: MARY ELIZABETH WHELAN 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
1133V00000XRegistered DietitianLD002670GA

General Provider Information

NPI Number : 1356491104
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH WHELAN RD
Provider Business Mailing Address
First Line : 1825 MARTHA BERRY BLVD NW
Second Line :
City : ROME
State : GA
Zip : 30165-1625
Country : US
Telephone Number : 706-295-5331
Fax Number :
Provider Business Practice Location Address
First Line : 19 REDMOND RD NW
Second Line :
City : ROME
State : GA
Zip : 30165-1533
Country : US
Telephone Number : 706-378-8129
Fax Number : 706-238-8037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/09/2007

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Directions to “ MARY ELIZABETH WHELAN RD” Practice Location

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