Your Dietitian LLC

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

LD001151 Issued in GA

Legal business name

YOUR DIETITIAN LLC

Practice address

2758 Felton Dr
East Point, GA 30344-3604

Phone

(770) 356-9468

Fax

(678) 547-3156

NPI assigned

Nov 23, 2009

Organization subpart

No

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

Authorized official

Name

Genevieve Broomfield, RD, CSR, LD

Title

Chief Operating Officer

Phone

(770) 356-9468

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1258934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1609104058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 NEEDLETOP CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534315",
            "telephone_number": "770-356-9468",
            "fax_number": "678-547-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2758 FELTON DR",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443604",
            "telephone_number": "770-356-9468",
            "fax_number": "678-547-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR DIETITIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-23",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "BROOMFIELD",
        "authorized_official_first_name": "GENEVIEVE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "770-356-9468",
        "authorized_official_credential": "RD, CSR, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD001151",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "GA",
            "license": "LD001151",
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "GA",
            "license": "LD001151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Renal Nutrition Registered Dietitian in East Point, GA
• Providers in East Point, GA by specialty
• Renal Nutrition Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.