Stacy Ann Paine, RD, LD
Individual provider Active NPI Registered Dietitian · Atlanta, GA
NPI 1154576445 · NPPES record last updated Mar 21, 2024
Key facts
- NPI
- 1154576445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- LD002157 (GA)
- Practice address
- 6674 Cadence Blvd
Atlanta, GA 30328-2874 - Phone
- (404) 937-3338
- Fax
- (404) 777-6469
- NPI assigned
- Dec 1, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100518000836 | GA | Practitioner - Registered Dietitian Or Nutrition Professional | 5092844720 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD002157 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oconee Nutrition Consultants, LLC | Dietitian, Registered | Current |
Accepting new patients |
| Nourished Well, LLC | Dietitian, Registered | Current |
Accepting new patients |
| Body for Life, LLC | Dietitian, Registered | Past | Accepting new patients |
| Beltline Bariatric and Surgical Group LLC | Past |
Accepting new patients | |
| Beltline Weight Loss LLC | Past |
Accepting new patients | |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Body for Life LLC | Past |
Accepting new patients |
Locations
1093 Lake Oconee Pkwy
Ste 108
Eatonton, GA 31024
Phone (706) 473-5801
1051 Park Dr
Greensboro, GA 30642
Phone (678) 773-1853
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD002157 | GA | Yes |
Addresses
Primary practice location
6674 Cadence Blvd
Atlanta, GA 30328-2874
Mailing address
1061 Whispering Lakes TRL
Madison, GA 30650-6325
Phone (678) 773-1853
Other practice location 1
1061 Whispering Lakes Trl
Madison, GA 30650-6325
Phone (678) 773-1853
Other providers in Atlanta, GA
- Pain Clinic of Aimr
- Pain Consultants of Atlanta LLC
- Pain Management of the South
- Pain Relief Network of the South
- Pain Specialty Center of Atlanta, P.C.
- Paisley Pediatric Therapy
- Gabriel Martin Pajares Hurtado
- Ezra I. Pak-Harvey
- Amelia Pak
- Gabrielle Pak
All providers in Atlanta, GA · Registered Dietitian in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.