Basic Information
| Provider Information | |||||||||
| NPI: | 1447274873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURVIS | ||||||||
| FirstName: | TANNA | ||||||||
| MiddleName: | SMITH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D.,L.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 S SEQUOYA DR | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301881744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709281390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 WHITCHER ST NE | ||||||||
| Address2: | SUITE 460 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704277389 | ||||||||
| FaxNumber: | 7704271492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | LD000243 | GA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.