Provider Demographics
NPI:1487991089
Name:HAJEK, RANDALYNN ELMORE (RD)
Entity type:Individual
Prefix:MISS
First Name:RANDALYNN
Middle Name:ELMORE
Last Name:HAJEK
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 1:10636 E BROOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9387
Mailing Address - Country:US
Mailing Address - Phone:810-845-2825
Mailing Address - Fax:
Practice Address - Street 1:1411 LANEY WALKER BLVD
Practice Address - Street 2:AN1301
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0002
Practice Address - Country:US
Practice Address - Phone:706-721-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered