Active NPI
Sara Michelle Wallace, RD
- Registered Dietitian
- Cartersville, GA
National Provider Identifier
1366265100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86030502
- Practice address
- 26 Twelve Oaks Dr SE
Cartersville, GA 30120-5801 - Phone
- (678) 796-5171
- NPI assigned
- Oct 31, 2024
- Last updated
- Oct 31, 2024
- 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 | 86030502 | GA | Primary |
Addresses
Primary practice location
26 Twelve Oaks Dr SE
Cartersville, GA 30120-5801
Mailing address
26 Twelve Oaks Dr SE
Cartersville, GA 30120-5801
Phone (678) 796-5171
Other names 1
- Mrs. Sara Michelle Guy
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86030502 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1366265100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 TWELVE OAKS DR SE",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301205801",
"telephone_number": "678-796-5171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 TWELVE OAKS DR SE",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301205801",
"telephone_number": "678-796-5171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "SARA",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-31",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "86030502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SARA",
"last_name": "GUY",
"middle_name": "MICHELLE",
"prefix": "MRS.",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Cartersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.