Provider Demographics
NPI:1679393219
Name:ATKINS, KATHLEEN LEE (RDN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEE
Last Name:ATKINS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SPRINGSHADE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7747
Mailing Address - Country:US
Mailing Address - Phone:678-386-7094
Mailing Address - Fax:
Practice Address - Street 1:205 SPRINGSHADE CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7747
Practice Address - Country:US
Practice Address - Phone:678-386-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA818675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered