Provider Demographics
NPI:1366278392
Name:PADDRIK, KELLY (RDN, LD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PADDRIK
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:402 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-4992
Mailing Address - Country:US
Mailing Address - Phone:229-869-3646
Mailing Address - Fax:
Practice Address - Street 1:402 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-4992
Practice Address - Country:US
Practice Address - Phone:229-869-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered