Provider Demographics
NPI:1285912477
Name:ANDRY, KAREN J (DIETITIAN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:ANDRY
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JERRIS
Other - Last Name:ANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:5115 NEW PEACHTREE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2326
Mailing Address - Country:US
Mailing Address - Phone:678-336-5951
Mailing Address - Fax:678-336-5955
Practice Address - Street 1:35 COLLIER ROAD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-350-7955
Practice Address - Fax:404-350-9115
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1285912477OtherNPI