Provider Demographics
NPI:1225900780
Name:LUSK, AVERY (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:LUSK
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 STRIPLING ST
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-4014
Mailing Address - Country:US
Mailing Address - Phone:678-410-1789
Mailing Address - Fax:
Practice Address - Street 1:145 STRIPLING ST
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-4014
Practice Address - Country:US
Practice Address - Phone:678-410-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty