Active NPI
Emilie Elisabeth Koetter, RDN, LD
- Registered Dietitian
- Canton, GA
National Provider Identifier
1821671256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD004598
- Practice address
- 704 Woodward CT
Canton, GA 30114-1501 - Phone
- (678) 371-1910
- NPI assigned
- May 3, 2021
- Last updated
- Mar 27, 2025
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.011134 | IL | |
| Registered Dietitian | 133V00000X | 2947 | AL | |
| Registered Dietitian | 133V00000X | LD004598 | GA | Primary |
Addresses
Primary practice location
704 Woodward CT
Canton, GA 30114-1501
Mailing address
1201 W Peachtree St NW Ste 2625
Atlanta, GA 30309-3499
Phone (678) 371-1910
Other practice location 1
16 E 12th St SW
Rome, GA 30161-4720
Phone (706) 295-6123
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD004598 | GA | MD | Registered Dietitian |
| 164.011134 | IL | MD | Registered Dietitian |
| 2947 | AL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life of Food LLC | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 3
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": "1620000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1821671256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 W PEACHTREE ST NW STE 2625",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303093499",
"telephone_number": "678-371-1910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 WOODWARD CT",
"city": "CANTON",
"state": "GA",
"postal_code": "301141501",
"telephone_number": "678-371-1910"
}
],
"practiceLocations": [
{
"address_1": "16 E 12th St SW",
"address_purpose": "LOCATION",
"city": "Rome",
"state": "GA",
"postal_code": "301614720",
"country_code": "US",
"telephone_number": "706-295-6123",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOETTER",
"first_name": "EMILIE",
"middle_name": "ELISABETH",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-03",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.011134",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AL",
"license": "2947",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD004598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.