Doctor Name: | ELLEN SURATT STANBACK |
NPI Number: | 1780768663 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD,LD,CLC |
License Number: | LD001907 |
Business Practice Address: | 2277 Stone Mountain Lithonia Rd Lithonia, GA - 300585252 |
Business Phone Number: | 7704842600 |
Business Fax Number: | 7704843830 |
Mailing Address: | 3177 Kensington Rd, AVONDALE ESTATES |
State: | GA |
Postal Code: | 300021457 |
Phone Number: | 4042991150 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | LD001907 |
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 |