Provider Demographics
NPI:1447274873
Name:PURVIS, TANNA SMITH (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:TANNA
Middle Name:SMITH
Last Name:PURVIS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S SEQUOYA DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1744
Mailing Address - Country:US
Mailing Address - Phone:770-928-1390
Mailing Address - Fax:
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-1492
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000243133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal