| Organization Name: | NUTRISOURCE NUTRITIONAL SERVICES, INC. |
| NPI Number: | 1932486966 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAUREN G. BAILEY (OWNER) |
| Mailing Address: | 504 Beachview Dr Suite 2a Saint Simons Island |
| State: | GA US |
| Postal Code: | 315224740 |
| Phone Number: | 9122227755 |
| Fax Number: | 9124347018 |
| NPI Enumeration Date: | 11/04/2011 |
| NPI Last Update Date: | 11/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | LD002579 |
| 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 |