Active NPI
Julie Wallace, RD,LD,CSP
- Registered Dietitian
- Marietta, GA
National Provider Identifier
1245755156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86006561
- Practice address
- 1229 Johnson Ferry Rd Ste 204B
Marietta, GA 30068-5416 - Phone
- (404) 692-6902
- NPI assigned
- Aug 11, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 | 86006561 | GA | Primary |
Addresses
Primary practice location
1229 Johnson Ferry Rd Ste 204B
Marietta, GA 30068-5416
Mailing address
3337 Preakness CT
Marietta, GA 30062-5553
Phone (404) 862-9337
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86006561 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planted in Nutrition, LLC | Dietitian, Registered | Current | Accepting new patients |
| Ikrdconsulting LLC | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Locations
1229 Johnson Ferry Rd
Ste 204B
Marietta, GA 30068
Phone (404) 692-6902
10 Glenlake Pkwy
Ste 130
Sandy Springs, GA 30328
Phone (678) 230-7095
Organizations & group practices 5
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1245755156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3337 PREAKNESS CT",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300625553",
"telephone_number": "404-862-9337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1229 JOHNSON FERRY RD STE 204B",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300685416",
"telephone_number": "404-692-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JULIE",
"credential": "RD,LD,CSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-11",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "86006561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.