Provider Demographics
NPI:1437346319
Name:PHILLIP, ROSALIND (RD)
Entity type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:
Last Name:PHILLIP
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 1:3605 LONGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-8301
Mailing Address - Country:US
Mailing Address - Phone:770-456-3195
Mailing Address - Fax:770-456-3351
Practice Address - Street 1:601 DALLAS HIGHWAY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-456-3195
Practice Address - Fax:770-456-3351
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered