Provider Demographics
NPI:1447772652
Name:GARGIS, EMILY BEATTY (MS, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BEATTY
Last Name:GARGIS
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2422
Mailing Address - Country:US
Mailing Address - Phone:662-292-3453
Mailing Address - Fax:
Practice Address - Street 1:900 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3203
Practice Address - Country:US
Practice Address - Phone:803-814-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered