Active NPI
Lisa Michelle Ellenberger, RD
- Registered Dietitian
- Woodstock, GA
National Provider Identifier
1649809401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD004985
- Practice address
- 316 Lakestone LNDG
Woodstock, GA 30188-5428 - Phone
- (678) 360-5796
- NPI assigned
- Apr 3, 2020
- Last updated
- Aug 31, 2022
- Sex
- Female
- 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 | LD004985 | GA | Primary |
Addresses
Primary practice location
316 Lakestone LNDG
Woodstock, GA 30188-5428
Mailing address
316 Lakestone LNDG
Woodstock, GA 30188-5428
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 |
|---|---|---|---|
| LD004985 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1649809401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "316 LAKESTONE LNDG",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301885428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 LAKESTONE LNDG",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301885428",
"telephone_number": "678-360-5796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENBERGER",
"first_name": "LISA",
"middle_name": "MICHELLE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-03",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD004985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.