Deja Ivy, MS, RD , LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD006151 Issued in GA

Practice address

1448 Jefferson Dr
Atlanta, GA 30350-7121

Phone

(773) 891-6240

NPI assigned

Nov 5, 2024

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

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661

  Dietitian, Registered

  NPD
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465

  Dietitian, Registered

  NPD (past)
• Openloop Healthcare Partners New Jersey PC

  • General Practice Physician
  • Jersey City, NJ
  • NPI 1588335152

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1417770629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1448 JEFFERSON DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303507121",
            "telephone_number": "773-891-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1448 JEFFERSON DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303507121",
            "telephone_number": "773-891-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "DEJA",
        "name_prefix": "Ms.",
        "credential": "MS, RD , LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-05",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD006151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Ivie, PA-C
• Brooke Ivler, LICSW
• Chinedu Ivonye, MD
• Leslie Ivory, C.S.A
• Tyler Marie Ivory, MD
• Alexander Taro Iwamoto, MD
• Sally Williams Iwamoto, M.D.
• Isabella Iwanicki
• Todd William Iwanicki, MD
• Kathryn Iwasaki, PA-C

• Registered Dietitian in Atlanta, GA
• Providers in Atlanta, 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 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.