Angelica B Davis, M.ED., RDN, LD

Individual provider Active NPI Registered Dietitian · Adairsville, GA

NPI 1093596124 · NPPES record last updated Oct 13, 2023

Key facts

NPI
1093596124
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
LD005579 (GA)
Practice address
18 Carson CT
Adairsville, GA 30103-3053
Phone
(334) 412-6534
NPI assigned
Oct 13, 2023
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
LD005579GAMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X LD005579 GA Yes

Addresses

Primary practice location

18 Carson CT
Adairsville, GA 30103-3053

Mailing address

18 Carson CT
Adairsville, GA 30103-3053
Phone (334) 412-6534

Other providers in Adairsville, GA

All providers in Adairsville, GA · Registered Dietitian in Georgia

Sources for this page

Verify at the official NPI Registry.