Provider Demographics
NPI:1144305418
Name:ACKERMAN, LILY (RD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:ACKERMAN
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 1:103 N LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9790
Mailing Address - Country:US
Mailing Address - Phone:864-560-6419
Mailing Address - Fax:864-560-7498
Practice Address - Street 1:100 E WOOD ST STE 101
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3001
Practice Address - Country:US
Practice Address - Phone:864-560-6419
Practice Address - Fax:864-560-7498
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered