Provider Demographics
NPI:1235604273
Name:ST. MARTIN, AKEENA KENNETTE (MS, RDN, LD)
Entity type:Individual
Prefix:MS
First Name:AKEENA
Middle Name:KENNETTE
Last Name:ST. MARTIN
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:MS
Other - First Name:AKEENA
Other - Middle Name:KENNETTE
Other - Last Name:ST. MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:840 PLUMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9020
Mailing Address - Country:US
Mailing Address - Phone:404-923-0223
Mailing Address - Fax:833-924-0340
Practice Address - Street 1:1775 PARKER RD SE BLDG C
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6654
Practice Address - Country:US
Practice Address - Phone:404-923-0223
Practice Address - Fax:833-924-0340
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005235133NN1002X, 133V00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach