Provider Demographics
NPI:1215621420
Name:SABOURIN, MEGAN (RD/LD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SABOURIN
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 FAIRHAVEN DR APT 6409
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0356
Mailing Address - Country:US
Mailing Address - Phone:989-395-6820
Mailing Address - Fax:
Practice Address - Street 1:818 SAINT SEBASTIAN WAY BLDG 2
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2651
Practice Address - Country:US
Practice Address - Phone:989-288-3142
Practice Address - Fax:706-774-4150
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered