Provider Demographics
NPI:1124840723
Name:GATTIKER, EMILY ANN (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:GATTIKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HARDIN DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1520
Mailing Address - Country:US
Mailing Address - Phone:706-765-7019
Mailing Address - Fax:
Practice Address - Street 1:9249 HIGHWAY 29 S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-6352
Practice Address - Country:US
Practice Address - Phone:706-227-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered