Provider Demographics
NPI:1861252140
Name:SOUL AND SOIL PLLC
Entity type:Organization
Organization Name:SOUL AND SOIL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN R.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:COLLUMS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:501-654-4125
Mailing Address - Street 1:1605 SIMMS ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6413
Mailing Address - Country:US
Mailing Address - Phone:501-654-4410
Mailing Address - Fax:
Practice Address - Street 1:740 S SALEM RD STE 103
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5520
Practice Address - Country:US
Practice Address - Phone:501-654-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty