MEDICARE: TELENUTRITION THERAPY INC

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

General Provider Information

NPI Number	:	1417260407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELENUTRITION THERAPY INC

Provider Business Mailing Address
First Line	:	810 CAMELLIA RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2734
Country	:	US
Telephone Number	:	706-951-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 CAMELLIA RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2734
Country	:	US
Telephone Number	:	706-951-8118
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NANCY WEBER
Credential	:	RD
Telephone Number	:	706-951-8118

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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