| NPI | 1285196477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YAQUTULLAH IBRAHEEM MUHAMMAD Owner Authorized User 404-454-7356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2024-02-08 |