Provider Demographics
NPI:1316821192
Name:CHERESTAL-IGE, GUERDA (RDN, LD)
Entity type:Individual
Prefix:
First Name:GUERDA
Middle Name:
Last Name:CHERESTAL-IGE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 OAK LN SW
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9194
Mailing Address - Country:US
Mailing Address - Phone:706-853-4165
Mailing Address - Fax:
Practice Address - Street 1:3654 OAK LN SW
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9194
Practice Address - Country:US
Practice Address - Phone:706-853-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered