Envision Nutrition Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD00262 Issued in GA

Legal business name

ENVISION NUTRITION INC.

Practice address

1922 Highway 74 N
Suite D
Tyrone, GA 30290-1660

Phone

(404) 797-0528

NPI assigned

Jun 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Donna P Decaille, RD

Title

Executive Director

Phone

(404) 797-0528

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1093036253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 HIGHWAY 74 N",
            "address_2": "SUITE D",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901660",
            "telephone_number": "404-797-0528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922 HIGHWAY 74 N",
            "address_2": "SUITE D",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901660",
            "telephone_number": "404-797-0528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION NUTRITION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "DECAILLE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "404-797-0528",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD00262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240270797A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Tyrone, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.