Provider Demographics
NPI:1871342832
Name:VERDEROSE DAVIS, JANIS M (RD LD)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:M
Last Name:VERDEROSE DAVIS
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MRS
Other - First Name:JANIS
Other - Middle Name:M
Other - Last Name:VERDEROSE DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LD
Mailing Address - Street 1:4125 PARAN POINTE DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3128
Mailing Address - Country:US
Mailing Address - Phone:973-943-3684
Mailing Address - Fax:
Practice Address - Street 1:4125 PARAN POINTE DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3128
Practice Address - Country:US
Practice Address - Phone:973-943-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005023133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered