Mary Novarah Mattiaccio, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD004495 Issued in GA

Practice address

2726 Oak Village TRL
Decatur, GA 30032-6496

Phone

(707) 387-6643

NPI assigned

Nov 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Novarah Ott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1376251074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 OAK VILLAGE TRL",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300326496",
            "telephone_number": "707-387-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2726 OAK VILLAGE TRL",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300326496",
            "telephone_number": "707-387-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIACCIO",
        "first_name": "MARY",
        "middle_name": "NOVARAH",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD004495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "OTT",
            "middle_name": "NOVARAH",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles David Matthews, M.S.
• Cindy Sue Matthews, PH.D.
• Leli Gail Matthews, M.D
• Necha Shani Matthews
• La-Tanya Rowe Matthias, MS,CCC-SLP
• Gideon Leigh Matzkin, MD
• Damon Van Mauldin, MD
• Christine Maurer, MPT
• Nicholas M. Maurice, M.D.
• Trisha Maurice, AU.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.