Active NPI
Lydia Aultman, REGISTERED DIETITIAN
- Registered Dietitian
- Waycross, GA
National Provider Identifier
1114153277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 006433
- Practice address
- 1900 Tebeau St
Waycross, GA 31501-6357 - Phone
- (912) 287-4271
- Fax
- (912) 338-6400
- NPI assigned
- Jun 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 006433 | NY | Primary |
Addresses
Primary practice location
1900 Tebeau St
Waycross, GA 31501-6357
Mailing address
1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 287-4271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432080000000",
"number": "1114153277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 TEBEAU ST",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315016357",
"telephone_number": "912-287-4271",
"fax_number": "912-338-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 TEBEAU ST",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315016357",
"telephone_number": "912-287-4271",
"fax_number": "912-338-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AULTMAN",
"first_name": "LYDIA",
"credential": "REGISTERED DIETITIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-03",
"last_updated": "2015-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "006433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waycross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.