Provider Demographics
NPI:1447994322
Name:HIS FRUIT LLC
Entity type:Organization
Organization Name:HIS FRUIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:404-317-5329
Mailing Address - Street 1:1921 MANHATTAN PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2244
Mailing Address - Country:US
Mailing Address - Phone:404-317-5329
Mailing Address - Fax:
Practice Address - Street 1:1921 MANHATTAN PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2244
Practice Address - Country:US
Practice Address - Phone:404-317-5329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty