Provider Demographics
NPI:1194258236
Name:VEITCH, LAUREN ALEXIS (RD, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:VEITCH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ALEXIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 41ST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6710
Mailing Address - Country:US
Mailing Address - Phone:706-324-0387
Mailing Address - Fax:
Practice Address - Street 1:1717 41ST ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6710
Practice Address - Country:US
Practice Address - Phone:706-324-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004697133V00000X
TN3236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered