Provider Demographics
NPI:1588364103
Name:LIPSCOMB, THAO UYEN (RD, CNSC)
Entity type:Individual
Prefix:
First Name:THAO UYEN
Middle Name:
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:THAO UYEN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:1120 15TH ST # BA1565
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3204
Mailing Address - Fax:706-721-0313
Practice Address - Street 1:1120 15TH ST # BA1565
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered