Provider Demographics
NPI:1285077560
Name:SANFORD, KATHERINE E (RD, LDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 HERRING WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4093
Mailing Address - Country:US
Mailing Address - Phone:401-932-1171
Mailing Address - Fax:
Practice Address - Street 1:2432 HERRING WOODS TRL
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4093
Practice Address - Country:US
Practice Address - Phone:401-932-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered