Provider Demographics
NPI:1366131971
Name:LEYDECKER, BARBARA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MARIE
Last Name:LEYDECKER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10247 HIGHWAY 92 UNIT 8-301
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3993
Mailing Address - Country:US
Mailing Address - Phone:404-626-9449
Mailing Address - Fax:
Practice Address - Street 1:290 KENNESAW STATE UNIVERSITY RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5590
Practice Address - Country:US
Practice Address - Phone:470-578-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered