Active NPI
Esleen Wilson
- Registered Dietitian
- Cumming, GA
National Provider Identifier
1588210959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1012391
- Practice address
- 4520 N River Dr
Cumming, GA 30041-9463 - Phone
- (770) 519-0004
- NPI assigned
- Aug 12, 2019
- 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 | 1012391 | GA | Primary |
Addresses
Primary practice location
4520 N River Dr
Cumming, GA 30041-9463
Mailing address
4520 N River Dr
Cumming, GA 30041-9463
Phone (770) 519-0004
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1012391 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1588210959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4520 N RIVER DR",
"city": "CUMMING",
"state": "GA",
"postal_code": "300419463",
"telephone_number": "770-519-0004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4520 N RIVER DR",
"city": "CUMMING",
"state": "GA",
"postal_code": "300419463",
"telephone_number": "770-519-0004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ESLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-12",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "1012391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.