Suzan Jackovatz, RDN, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD001330 Issued in GA

Practice address

5528 Ridgemoor Dr
Braselton, GA 30517-1226

Phone

(678) 997-7421

NPI assigned

Jun 5, 2015

Last updated

Jun 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1433462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1578943437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5528 RIDGEMOOR DR",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305171226",
            "telephone_number": "678-997-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5528 RIDGEMOOR DR",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305171226",
            "telephone_number": "678-997-7421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKOVATZ",
        "first_name": "SUZAN",
        "credential": "RDN, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD001330",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "SC",
            "license": "1217",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Hublall, DMD
• Christopher R Huckle, D.O.
• Abigayle Hughes, RDN
• Tappie Faye Hurdelbrink, CNM
• Krystal N Ikemba-Madu, PHARMD
• Yoomi Jang
• Holly Amber Johns, FNP-BC
• Connie Johnson
• Kelley L Johnson, FNP-BC
• Johnsons Hometown Pharmacy Inc (Johnson's River Place Pharmacy)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.