Doctor Name: | CRYSTAL MARIE SHORES |
NPI Number: | 1629348727 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | LD003806 |
Business Practice Address: | 5150 Davidson Road Marietta, GA - 30068 |
Business Phone Number: | 6782098976 |
Business Fax Number: | |
Mailing Address: | 4880 Lower Roswell Rd, Suite 165-142 MARIETTA |
State: | GA |
Postal Code: | 300684375 |
Phone Number: | 6782098976 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2012 |
NPI Last Update Date: | 01/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | LD003806 |
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 |