| Dietitian Services Llc | |
|
1315 Matthews Mint Hill Rd Ste B Matthews NC 28105-2694 | |
| (704) 277-9059 | |
| Not Available |
| Full Name | Dietitian Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1315 Matthews Mint Hill Rd Ste B, Matthews, North Carolina |
| Authorized Official Name and Position | Jason Russo (OWNER MANAGER) |
| Authorized Official Contact | 7042779059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dietitian Services Llc 12113 Landen Dr Charlotte NC 28277-4664 Ph: () - | Dietitian Services Llc 1315 Matthews Mint Hill Rd Ste B Matthews NC 28105-2694 Ph: (704) 277-9059 |
| NPI Number | 1982311809 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 10/31/2022 |
| Medicare PECOS PAC ID | 6507237856 |
|---|---|
| Medicare Enrollment ID | O20230124001214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982311809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Coretta Queen Chaffin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1255944716 PECOS PAC ID: 9234558743 Enrollment ID: I20201002000948 |
| Provider Name | Jillian Harrell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417666264 PECOS PAC ID: 1456713627 Enrollment ID: I20230821000933 |
| Provider Name | Jill Jaffe Durinick |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1033993340 PECOS PAC ID: 7012362445 Enrollment ID: I20231004003523 |
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