Provider Demographics
NPI:1629118096
Name:BELL, SUSAN MARIE (RD, LD, CLC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 GENERAL JACKSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549
Mailing Address - Country:US
Mailing Address - Phone:706-367-5204
Mailing Address - Fax:706-367-9023
Practice Address - Street 1:341 GENERAL JACKSON DRIVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549
Practice Address - Country:US
Practice Address - Phone:706-367-5204
Practice Address - Fax:706-367-9023
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered