MEDICARE: ALLOUTWELL LLC

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	:	1518828284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLOUTWELL LLC

Provider Business Mailing Address
First Line	:	8958 W STATE ROAD 84 # 1022
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 WATSON BLVD # 1154
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3436
Country	:	US
Telephone Number	:	754-777-0917
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	MARCIA SAINT VICTOR
Credential	:	RD
Telephone Number	:	754-777-0917

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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Directions to “ALLOUTWELL LLC ” Practice Location

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