Provider Demographics
NPI:1992427645
Name:SUITABLE NUTRITION, LLC
Entity type:Organization
Organization Name:SUITABLE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-961-1778
Mailing Address - Street 1:630 RIVER FALLS CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5120
Mailing Address - Country:US
Mailing Address - Phone:518-961-1778
Mailing Address - Fax:
Practice Address - Street 1:630 RIVER FALLS CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5120
Practice Address - Country:US
Practice Address - Phone:518-961-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD004817OtherGEORGIA PROFESSIONAL LICENSING BOARDS DIVISION