Active NPI
Mary Louise Slullivan, R.D., LD, MA
- Registered Dietitian
- Augusta, GA
National Provider Identifier
1932329646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD000433
- Practice address
- 2361 Tobacco Rd
Augusta, GA 30906-9220 - Phone
- (706) 793-4401
- Fax
- (706) 790-4372
- NPI assigned
- Apr 26, 2007
- 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 | LD000433 | GA | Primary |
Addresses
Primary practice location
2361 Tobacco Rd
Augusta, GA 30906-9220
Mailing address
3522 Hilltop Dr
Augusta, GA 30906-5732
Phone (706) 796-8739
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD000433 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932329646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3522 HILLTOP DR",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309065732",
"telephone_number": "706-796-8739",
"fax_number": "706-796-6075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2361 TOBACCO RD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309069220",
"telephone_number": "706-793-4401",
"fax_number": "706-790-4372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLULLIVAN",
"first_name": "MARY",
"middle_name": "LOUISE",
"credential": "R.D., LD, MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD000433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.