Provider Demographics
NPI:1902793722
Name:KIRKLAND, VIRGINIA (RD, LD, CECES)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:RD, LD, CECES
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-281-6107
Mailing Address - Fax:229-281-6097
Practice Address - Street 1:209 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-281-6107
Practice Address - Fax:229-281-6097
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered