Provider Demographics
NPI:1689494296
Name:RUSSELL NUTRITION LLC
Entity type:Organization
Organization Name:RUSSELL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:404-314-4014
Mailing Address - Street 1:6275 OLD HICKORY PT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3618
Mailing Address - Country:US
Mailing Address - Phone:404-314-4014
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD STE D125
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2113
Practice Address - Country:US
Practice Address - Phone:404-314-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty