Provider Demographics
NPI:1447462411
Name:KOCH, HELEN BAILEY (RD, CSP, LD)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:BAILEY
Last Name:KOCH
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:MRS
Other - First Name:BAILEY
Other - Middle Name:MARTIN
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CSP, LD
Mailing Address - Street 1:140 ROCKY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6246
Mailing Address - Country:US
Mailing Address - Phone:404-543-3897
Mailing Address - Fax:404-745-0808
Practice Address - Street 1:140 ROCKY CREEK TRL
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6246
Practice Address - Country:US
Practice Address - Phone:404-543-3897
Practice Address - Fax:404-745-0808
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002614133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA922309OtherREGISTRATION NUMBER
GALD002614OtherSTATE LICENSE