| NPI | 1992005805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETONYA SHAW Director 336-253-1268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine |
| Additional Taxonomies | 251S00000X |
| 252Y00000X Early Intervention Provider Agency | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 208000000X Pediatrics | |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2011-03-04 |