MEDICARE: WARD DIETETICS, 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	:	1952848038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARD DIETETICS, LLC

Provider Business Mailing Address
First Line	:	6215 HUMPHREYS BLVD
Second Line	:	SUITE 501
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4561 SEQUOIA AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-1719
Country	:	US
Telephone Number	:	901-212-0288
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	ALAINA WARD
Credential	:	RD
Telephone Number	:	901-212-0288

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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