Real Food Charlotte, Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L003989 Issued in NC

Legal business name

REAL FOOD CHARLOTTE, INC.

Practice address

6135 Park South Dr
Charlotte, NC 28210-3272

Phone

(407) 408-7242

NPI assigned

Jun 29, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Annette T Habecker, RD,LDN

Title

President

Phone

(407) 408-7242

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1629429824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 HOLYOKE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282266898",
            "telephone_number": "407-408-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6135 PARK SOUTH DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103272",
            "telephone_number": "407-408-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REAL FOOD CHARLOTTE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "HABECKER",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-408-7242",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RD,LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L003989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1053664383",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DT1060",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.