Active NPI
Daniel Ticona, RDN
- Registered Dietitian
- Fort Gordon, GA
National Provider Identifier
1639001050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2019029807
- Practice address
- 300 E Hospital Rd
Fort Gordon, GA 30905 - Phone
- (706) 787-5811
- NPI assigned
- Jun 1, 2026
- Sex
- Male
- Sole proprietor
- No
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 | 2019029807 | MO | Primary |
Addresses
Primary practice location
300 E Hospital Rd
Fort Gordon, GA 30905
Mailing address
1094 Maple Ridge CT
Evans, GA 30809-5248
Phone (636) 614-5251
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019029807 | MO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1780272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780272000000",
"number": "1639001050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1094 MAPLE RIDGE CT",
"city": "EVANS",
"state": "GA",
"postal_code": "308095248",
"telephone_number": "636-614-5251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E HOSPITAL RD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-5811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICONA",
"first_name": "DANIEL",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-06-01",
"last_updated": "2026-06-01",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2019029807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.