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MRS. DONNA P DECAILLE RD

>> Dietitian, Registered >> Dietary & Nutritional Service Providers

Registrant NPI Number: 1437102530

Individual Registrant:
MRS. DONNA P DECAILLE RD
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1922 HIGHWAY 74 N SUITE D TYRONE, GA 30290-1660 US
Tel: 404-797-0528  Fax: 678-489-8957

Contact information for business:
1922 HIGHWAY 74 N SUITE D TYRONE, GA 30290-1660 US
Tel: 404-797-0528  Fax: 678-489-8957

Registration Information:
NPI: 1437102530
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y133V00000XDietary & Nutritional Service Providers
Dietitian, Registered
GALD002627

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
24020797AGA05




HEALTH CARE JOBS GA - Page 1



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