| Doctor Name: | MISS JESSICA DENISE MACK |
| NPI Number: | 1598972044 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, RD, LD |
| License Number: | LD002855 |
| Business Practice Address: | 705 Dallas Hwy Villa Rica, GA - 301801247 |
| Business Phone Number: | 7704563249 |
| Business Fax Number: | 7704563351 |
| Mailing Address: | 5497 Lakeview Pkwy, VILLA RICA |
| State: | GA |
| Postal Code: | 301807856 |
| Phone Number: | 7704563249 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | LD002855 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |