Basic Information
| Provider Information | |||||||||
| NPI: | 1578285102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTY | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | RDN, LDN, CDCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 AVOYELLES ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712012405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254853860 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2104 LOOP RD STE C | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184354571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2022 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2718 | LA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.