MEDICARE: MOLLY LADERER PAULSON RD, 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	LD002802	GA

General Provider Information

NPI Number	:	1629786736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY LADERER PAULSON RD, LD

Provider Business Mailing Address
First Line	:	816 VIRGINIA PARK CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4095
Country	:	US
Telephone Number	:	404-428-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 VIRGINIA PARK CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4095
Country	:	US
Telephone Number	:	404-428-9671
Fax Number	:

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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