Provider Demographics
NPI:1427213248
Name:DYNAMIC DIETETICS
Entity type:Organization
Organization Name:DYNAMIC DIETETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LDN
Authorized Official - Phone:423-339-1415
Mailing Address - Street 1:8948 LONG SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5702
Mailing Address - Country:US
Mailing Address - Phone:423-339-1415
Mailing Address - Fax:423-339-1715
Practice Address - Street 1:8948 LONG SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5702
Practice Address - Country:US
Practice Address - Phone:423-339-1415
Practice Address - Fax:423-339-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty