Provider Demographics
NPI:1316286602
Name:LEVITCH, DAVID (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEVITCH
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:PO BOX 26048
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3031
Mailing Address - Country:US
Mailing Address - Phone:404-616-4338
Mailing Address - Fax:404-616-2422
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-4338
Practice Address - Fax:404-616-2422
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001865133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered