Basic Information
| Provider Information | |||||||||
| NPI: | 1467992693 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALGOUST | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 JEFFERSON AVE | ||||||||
| Address2: | ROOM 202 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014486523 | ||||||||
| FaxNumber: | 9014484764 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014486511 | ||||||||
| FaxNumber: | 9014483844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2017 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2226 | TN | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1006X | 2226 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.