Active NPI
Grace Marie Nystrom, MS, RDN, LD
- Registered Dietitian
- Atlanta, GA
National Provider Identifier
1396540134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD006719
- Practice address
- 8196 Brookwood Valley Cir NE
Atlanta, GA 30309-1458 - Phone
- (973) 780-7228
- NPI assigned
- Feb 17, 2025
- 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 | LD006719 | GA | Primary |
Addresses
Primary practice location
8196 Brookwood Valley Cir NE
Atlanta, GA 30309-1458
Mailing address
8196 Brookwood Valley Cir NE
Atlanta, GA 30309-1458
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD006719 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739750400000",
"number": "1396540134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8196 BROOKWOOD VALLEY CIR NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8196 BROOKWOOD VALLEY CIR NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091458",
"telephone_number": "973-780-7228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYSTROM",
"first_name": "GRACE",
"middle_name": "MARIE",
"credential": "MS, RDN, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-02-17",
"last_updated": "2025-02-17",
"certification_date": "2025-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD006719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.