Provider Demographics
NPI:1043087083
Name:MAKNOON, BABAK ROBERT (RD)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:ROBERT
Last Name:MAKNOON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W PEACHTREE ST NW UNIT 1118
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2541
Mailing Address - Country:US
Mailing Address - Phone:310-699-5489
Mailing Address - Fax:
Practice Address - Street 1:880 W PEACHTREE ST NW UNIT 1118
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2541
Practice Address - Country:US
Practice Address - Phone:310-699-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86034070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered