Active NPI
Carol Ann Brannon, MS RDN LD
- Registered Dietitian
- Duluth, GA
National Provider Identifier
1619418274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 000373
- Practice address
- 10475 Medlock Bridge Rd
Suite 205
Duluth, GA 30097-4433 - Phone
- (404) 409-1747
- Fax
- (404) 601-6018
- NPI assigned
- Mar 15, 2017
- 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 | 000373 | GA | Primary |
Addresses
Primary practice location
10475 Medlock Bridge Rd
Suite 205
Duluth, GA 30097-4433
Mailing address
10475 Medlock Bridge Rd Ste 205
Johns Creek, GA 30097-4446
Phone (404) 409-1747
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000373 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1619418274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10475 MEDLOCK BRIDGE RD STE 205",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300974446",
"telephone_number": "404-409-1747",
"fax_number": "404-601-6018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10475 MEDLOCK BRIDGE RD",
"address_2": "SUITE 205",
"city": "DULUTH",
"state": "GA",
"postal_code": "300974433",
"telephone_number": "404-409-1747",
"fax_number": "404-601-6018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANNON",
"first_name": "CAROL",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "MS RDN LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-15",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "000373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.