Provider Demographics
NPI:1992004519
Name:SUMNER, KAREN BALDREE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BALDREE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CHAPMAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-3574
Mailing Address - Country:US
Mailing Address - Phone:229-646-6059
Mailing Address - Fax:
Practice Address - Street 1:129 CHAPMAN FARM RD
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3574
Practice Address - Country:US
Practice Address - Phone:229-646-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008303-01133V00000X
SC806133VN1004X
GALD003030133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered