North Georgia Nutrition and Wellness LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD001208 Issued in GA

Legal business name

NORTH GEORGIA NUTRITION AND WELLNESS LLC

Practice address

3617 Braselton Hwy
Suite 104
Dacula, GA 30019-4667

Phone

(770) 718-6736

NPI assigned

Jun 30, 2014

Last updated

Jun 30, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leslie DavisNPI 1336580307

Title

President

Phone

(770) 718-6736

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leslie Conger Davis, RD, LD, CDE

  • Registered Dietitian
  • Dacula, GA
  • NPI 1336580307
  Authorized official Same address or phone

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1184039935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 LEGISLATIVE LN",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305198037",
            "telephone_number": "770-718-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 BRASELTON HWY",
            "address_2": "SUITE 104",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194667",
            "telephone_number": "770-718-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH GEORGIA NUTRITION AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-718-6736"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD001208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.