Provider Demographics
NPI:1962782953
Name:NUTRITION SOLUTIONS GROUP
Entity type:Organization
Organization Name:NUTRITION SOLUTIONS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, RD, LDN
Authorized Official - Phone:301-943-2250
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0985
Mailing Address - Country:US
Mailing Address - Phone:301-943-2250
Mailing Address - Fax:
Practice Address - Street 1:15 NOBLE ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9300
Practice Address - Country:US
Practice Address - Phone:301-943-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003168133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty