Provider Demographics
NPI:1316664626
Name:HARDIN, DASHA (RD, LD)
Entity type:Individual
Prefix:
First Name:DASHA
Middle Name:
Last Name:HARDIN
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 1:4318 THRUSH CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4415
Mailing Address - Country:US
Mailing Address - Phone:850-624-2583
Mailing Address - Fax:
Practice Address - Street 1:4318 THRUSH CT
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4415
Practice Address - Country:US
Practice Address - Phone:850-624-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered