Provider Demographics
NPI:1447965637
Name:DIETITIAN GROUP, LLC
Entity type:Organization
Organization Name:DIETITIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:WOODALL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MDA, RD, LDN, CDCES
Authorized Official - Phone:615-709-0903
Mailing Address - Street 1:615 MAIN ST STE M1
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3603
Mailing Address - Country:US
Mailing Address - Phone:615-709-0903
Mailing Address - Fax:855-634-2216
Practice Address - Street 1:615 MAIN ST STE M1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3603
Practice Address - Country:US
Practice Address - Phone:615-709-0903
Practice Address - Fax:855-634-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty