Active NPI
Charleen A Sibley
- Registered Dietitian
- Lagrange, GA
National Provider Identifier
1932475092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD000922
- Practice address
- 1514 Vernon Rd
Lagrange, GA 30240-4131 - Phone
- (706) 616-8072
- Fax
- (706) 812-2401
- NPI assigned
- Mar 22, 2012
- Last updated
- May 23, 2014
- 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 | LD000922 | GA | Primary |
Addresses
Primary practice location
1514 Vernon Rd
Lagrange, GA 30240-4131
Mailing address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 616-8072
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 |
|---|---|---|---|
| LD000922 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400803200000",
"number": "1932475092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1514 VERNON RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404131",
"telephone_number": "706-616-8072",
"fax_number": "706-812-2401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 VERNON RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404131",
"telephone_number": "706-616-8072",
"fax_number": "706-812-2401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIBLEY",
"first_name": "CHARLEEN",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-22",
"last_updated": "2014-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD000922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lagrange, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.