MARY ETTA JAMES GRESHAM


Address: 5330 Cayuga Ct, Lithonia, GA 30038-1106
Phone: 4045786525

MARY ETTA JAMES GRESHAM (NPI# 1316057862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1316057862
Entity Type Individual
Full Name MARY ETTA JAMES GRESHAM
Other Name MARY ETTA JAMES
Credential R.D.L.D.
Practice Address 5330 Cayuga Ct
Lithonia
GA 30038-1106
Practice Telephone 4045786525
Mailing Telephone 4045786525
Enumeration Date 2006-08-30
Last Update Date 2008-07-31
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 133VN1005X Dietitian, Registered
Specialization: Nutrition, Renal
LD000377 GA Dietary & Nutritional Service Providers

Office Location

Street Address 5330 CAYUGA CT
City LITHONIA
State GA
Zip Code 30038-1106

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1043579402 Elizabeth Anne Berlin Physician Assistant 8825 Mall Parkway, Suite 150, Lithonia, GA 30038 2012-05-04
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Taxonomy Information

Taxonomy Code 133VN1005X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered
Specialization Nutrition, Renal

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1164838173 Sally Butler Stieghan Dietitian, Registered 222 14th St Ne Apt 213, Atlanta, GA 30309-7681 2014-07-10
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1073793766 Christy Leigh Roberts Dietitian, Registered 190 Calhoun Rd, Griffin, GA 30224-7829 2007-11-09
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1487873352 Cynthia Goudeau Dietitian, Registered 1830 Niskey Cove Rd Sw, Atlanta, GA 30331-6339 2007-04-25
1457440786 Amanda Jo Redden Dietitian, Registered 22 Camden Cir, Newnan, GA 30265-5551 2006-10-12
1376579656 Melissa Ann Krentzman Dietitian, Registered 1685 Barfield Run Nw, Atlanta, GA 30318-2778 2006-06-25
1134164346 Rachel Rene Dartt Dietitian, Registered 10218 Madison Dr, Atlanta, GA 30346-2468 2006-06-19
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Competitor

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City LITHONIA
Zip Code 30038

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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