Most Relevant Information
Provider Data
| NPI Number: | 1003423625 |
| Provider Name: | KENRESE THERESA CARTER MS,CNS |
| Entity Type: | Individual |
| Taxonomy Code: | 133N00000X |
| Specialty: | Nutritionist |
| License Number: | DX5094 |
Most Important Dates
| Enumeration Date: | 09/28/2020 |
| Last Updated: | 10/24/2024 |
Provider Practice Location
4344 FAWN LN SE
SMYRNA
GA
300823951
Practice Location Phone/Fax
| Phone: | 4043973009 |
| Fax: |
Provider Mailing Location
4344 FAWN LN SE
SMYRNA
GA
300823951
Provider Mailing Phone/Fax
| Phone: | 4043973009 |
| Fax: |