Sprout Pediatric Nutrition LLC

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

Legal business name

SPROUT PEDIATRIC NUTRITION LLC

Practice address

4045 Orchard Rd SE Ste 500
Smyrna, GA 30080-4900

Phone

(404) 654-3906

NPI assigned

Jun 12, 2023

Organization subpart

No

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

Authorized official

Name

Caitlin Waddle, MS, RDN, LDNPI 1205218872

Title

Owner

Phone

(404) 654-3906

Specialties & licenses 1

Addresses

Practitioners 1

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

• Caitlin Waddle, MS, RDN, LD

  • Pediatric Nutrition Registered Dietitian
  • Smyrna, GA
  • NPI 1205218872

  Nutrition, Pediatric

  NPD Authorized official

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1609550599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2062 VILLAGE CREST DR NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303181064",
            "telephone_number": "502-648-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 ORCHARD RD SE STE 500",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804900",
            "telephone_number": "404-654-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPROUT PEDIATRIC NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "WADDLE",
        "authorized_official_first_name": "CAITLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-654-3906",
        "authorized_official_credential": "MS, RDN, LD"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Nutrition Registered Dietitian in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Pediatric Nutrition Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.