Provider Demographics
NPI:1427574185
Name:HARBIN, KRISTEN LAYFIELD
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LAYFIELD
Last Name:HARBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 ARBOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7003
Mailing Address - Country:US
Mailing Address - Phone:678-570-5657
Mailing Address - Fax:
Practice Address - Street 1:827 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680
Practice Address - Country:US
Practice Address - Phone:678-570-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2024-08-26
Deactivation Date:2020-06-02
Deactivation Code:
Reactivation Date:2024-08-20
Provider Licenses
StateLicense IDTaxonomies
GALD004661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered