Southern Nutrition and Wellness

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD004663 Issued in GA

Legal business name

SOUTHERN NUTRITION AND WELLNESS

Practice address

6073 Luke Rd
Ray City, GA 31645-2119

Phone

(229) 546-7585

NPI assigned

Jul 25, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Kati Rebecca Wise, MS, RD, LD

Title

Licensed Dietitian

Phone

(229) 546-7585

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1356828925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6073 LUKE RD",
            "city": "RAY CITY",
            "state": "GA",
            "postal_code": "316452119",
            "telephone_number": "229-546-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6073 LUKE RD",
            "city": "RAY CITY",
            "state": "GA",
            "postal_code": "316452119",
            "telephone_number": "229-546-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NUTRITION AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "KATI",
        "authorized_official_middle_name": "REBECCA",
        "authorized_official_title_or_position": "LICENSED DIETITIAN",
        "authorized_official_telephone_number": "229-546-7585",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD004663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy C Pearson, ARNP
• Erin Harrell Ray, LCSW
• Lynn Roberts
• Miranda Moneke Robinson
• Sarah P Smith, LCSW

• Registered Dietitian in Ray City, GA
• Providers in Ray City, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; 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.