Provider Demographics
NPI:1174330435
Name:HANNAH, CAROLEE (RD)
Entity type:Individual
Prefix:
First Name:CAROLEE
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 COLE CIR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2524
Mailing Address - Country:US
Mailing Address - Phone:678-787-8533
Mailing Address - Fax:
Practice Address - Street 1:50 GLENLAKE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-7270
Practice Address - Country:US
Practice Address - Phone:678-328-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered