Provider Demographics
NPI:1972375673
Name:PATH OF LIFE NUTRITION
Entity type:Organization
Organization Name:PATH OF LIFE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD, IFNCP
Authorized Official - Phone:803-575-0468
Mailing Address - Street 1:736 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3751
Mailing Address - Country:US
Mailing Address - Phone:803-575-0468
Mailing Address - Fax:803-728-3224
Practice Address - Street 1:446 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7618
Practice Address - Country:US
Practice Address - Phone:803-575-0468
Practice Address - Fax:803-728-3224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATH OF LIFE NUTRITION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty