Elissaveta B Johnson, M. S., R.D., L.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD003412 Issued in GA

Practice address

601 Dallas Hwy
Villa Rica, GA 30180-1202

Phone

(770) 456-3249

Fax

(770) 456-3351

NPI assigned

Mar 5, 2010

Last updated

Mar 5, 2010By the provider in NPPES

Sex

Female

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)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1267747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267747200000",
    "number": "1134442122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 SHADED OASIS LN",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301806966",
            "telephone_number": "706-506-5379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 DALLAS HWY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801202",
            "telephone_number": "770-456-3249",
            "fax_number": "770-456-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELISSAVETA",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "M. S., R.D., L.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-05",
        "last_updated": "2010-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD003412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Poole OD and Associates
• Alicia M Jennings, MD
• Michelae Jennings
• Lynette Jensen, M.ED., CCC-SLP
• Farah Jiwani, DMD
• La-Vonnie Joiner, PMHNP
• Jordan Armani Jones, ED.S, LPC, NCC
• Joseph P. Whitehead D.C.P.C. (Axiom Chiropractic)
• Joseph S. Palin, M.D.
• Esther Joseph-Pierre, NP

• Registered Dietitian in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.