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1376251074
MARY NOVARAH MATTIACCIO
DECATUR, GA
NPI
1376251074
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Former Name
MARY NOVARAH OTT
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
133V00000X Dietitian, Registered
(Licence: GA LD004495)
Enumeration Date
2022-11-10
Last Update Date
2022-11-10
Business Address
MARY NOVARAH MATTIACCIO RD
2726 OAK VILLAGE TRL
DECATUR, GA 30032-6496
Phone number: 707-387-6643
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Mailing Address
MARY NOVARAH MATTIACCIO RD
2726 OAK VILLAGE TRL
DECATUR, GA 30032-6496
Phone number: 707-387-6643
Copy
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