Misty Clackum Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

MISTY CLACKUM NUTRITION LLC

Practice address

1814 Treesort VW
Gainesville, GA 30506-5383

Phone

(423) 284-5512

Fax

(770) 470-0770

NPI assigned

Jul 26, 2025

Organization subpart

No

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

Authorized official

Name

Misty Mullins Clackum, RD, CSP, LDNNPI 1073944492

Title

Owner

Phone

(423) 284-5512

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Misty Mullins Clackum, RD, CSP, LDN

  • Registered Dietitian
  • Gainesville, GA
  • NPI 1073944492

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1753488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753488000000",
    "number": "1467335786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 TREESORT VW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305065383",
            "telephone_number": "423-284-5512",
            "fax_number": "770-470-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 TREESORT VW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305065383",
            "telephone_number": "423-284-5512",
            "fax_number": "770-470-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTY CLACKUM NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-26",
        "last_updated": "2025-07-26",
        "certification_date": "2025-07-26",
        "status": "A",
        "authorized_official_last_name": "CLACKUM",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "MULLINS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-284-5512",
        "authorized_official_credential": "RD, CSP, LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eddie H Mimbs, RPH
• Gary M Minkiewicz, MD
• James Minton
• Russell H. Mionie, D.C.
• Lacey Ashton Miranda, PA
• Mary McCartney Mitchell, RNFA, NP
• Anusha Mittal
• John Delano Mixon Sr., DDS
• Da Eun Mo, PHARM D
• Courtney Lee Modesitt, MS,OT

• Registered Dietitian in Gainesville, GA
• Providers in Gainesville, 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 26, 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.

Verify at the official NPI Registry.