Gary Alan Youngblood Jr., RD, LD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD002323 Issued in GA

Practice address

141 Nandina Way
Pooler, GA 31322-4076

Phone

(912) 660-1215

NPI assigned

Sep 24, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Nutrition Specialists, LLC

  • Registered Dietitian
  • Pooler, GA
  • NPI 1548592264

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1253750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253750400000",
    "number": "1104150192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 NANDINA WAY",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224076",
            "telephone_number": "912-660-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 NANDINA WAY",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224076",
            "telephone_number": "912-660-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "GARY",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "RD, LD, CDE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-24",
        "last_updated": "2009-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD002323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xcellent Healthcare Services
• Rediet G Yemane
• Zykia Yong
• Caitlin C Young, NP
• Kensheilah Denean Young, CD
• Shadee Zarei Chashtry
• Zellweger Family Chiropractic
• Elizabeth Maycock Zollinger, AU.D.
• Lawrence F Zottoli, MD

• Registered Dietitian in Pooler, GA
• Providers in Pooler, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; 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.