Florestan, Mary Ann B

Florestan, Mary Ann B is an sole proprietor health care provider with primary practice located at 4757 Canton Rd Suite 110, Marietta GA 30066-3234. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Florestan, Mary Ann B can be contacted via phone (770) 517-0105.

Contact Information

Primary practice address
4757 Canton Rd Suite 110 Marietta GA 30066-3234
Phone: (770) 517-0105
Fax: (770) 517-0105
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 001660 Georgia

Profile Details

NPI number 1477610095
LBN Legal business name Florestan, Mary Ann B
Credentials RD, LD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 2nd, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477610095 NPPES
Georgia Other 10040673 AMERIGROUP
Georgia Other 332644 AMERIGROUP

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