Provider Demographics
NPI:1578201950
Name:NUTRITION IAM LLC
Entity type:Organization
Organization Name:NUTRITION IAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:ABIGIAL
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:706-627-5864
Mailing Address - Street 1:417 S JEFFORDS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-3129
Mailing Address - Country:US
Mailing Address - Phone:706-627-5864
Mailing Address - Fax:
Practice Address - Street 1:417 S JEFFORDS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-3129
Practice Address - Country:US
Practice Address - Phone:706-627-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDT1134Medicaid