Provider Demographics
NPI:1861516908
Name:JAMES, RHONDA MACK (RD)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:MACK
Last Name:JAMES
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 1:4171 JOHN W BURROUGHS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:GA
Mailing Address - Zip Code:30421-8851
Mailing Address - Country:US
Mailing Address - Phone:912-693-2017
Mailing Address - Fax:912-538-5548
Practice Address - Street 1:1703 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8915
Practice Address - Country:US
Practice Address - Phone:912-538-5569
Practice Address - Fax:912-538-5548
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA726660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBSQMedicare ID - Type Unspecified