Active NPI
Diane Smith Elliott, R.D.
- Registered Dietitian
- College Park, GA
National Provider Identifier
1720389372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD003614
- Practice address
- 5765 Koweta Rd
College Park, GA 30349-1622 - Phone
- (770) 969-2556
- Fax
- (770) 969-2556
- NPI assigned
- Nov 13, 2010
- 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 | LD003614 | GA | Primary |
Addresses
Primary practice location
5765 Koweta Rd
College Park, GA 30349-1622
Mailing address
5765 Koweta Rd
College Park, GA 30349-1622
Phone (770) 969-2556
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 |
|---|---|---|---|
| LD003614 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289606400000",
"number": "1720389372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5765 KOWETA RD",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303491622",
"telephone_number": "770-969-2556",
"fax_number": "770-969-2556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5765 KOWETA RD",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303491622",
"telephone_number": "770-969-2556",
"fax_number": "770-969-2556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "DIANE",
"middle_name": "SMITH",
"name_prefix": "Mrs.",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-13",
"last_updated": "2010-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD003614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.