NPIMap

Organization Active NPI

Nutrisource Nutritional Services, Inc.

  • Registered Dietitian
  • Saint Simons Island, GA
National Provider Identifier
1932486966
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
LD002579 Issued in GA
Legal business name
NUTRISOURCE NUTRITIONAL SERVICES, INC.
Practice address
504 Beachview Dr
Suite 2a
Saint Simons Island, GA 31522-4740
Phone
(912) 222-7755
Fax
(912) 434-7018
NPI assigned
Nov 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lauren G. Bailey, R.D.NPI 1750684114
Title
Owner
Phone
(912) 222-7755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X LD002579 GA Primary

Addresses

Primary practice location

504 Beachview Dr
Suite 2a
Saint Simons Island, GA 31522-4740

Mailing address

620 Sea Island Rd
PMB 273
Saint Simons Island, GA 31522-1767
Phone (912) 222-7755

Other names 1

  • NutriSource, Inc. Former legal business name

National Provider Directory

National Provider Directory

Locations

504 Beachview Dr
Ste 2A
St Simons Island, GA 31522
Phone (912) 222-7755

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1932486966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SEA ISLAND RD",
            "address_2": "PMB 273",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315221767",
            "telephone_number": "912-222-7755",
            "fax_number": "912-434-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 BEACHVIEW DR",
            "address_2": "SUITE 2A",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315224740",
            "telephone_number": "912-222-7755",
            "fax_number": "912-434-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRISOURCE NUTRITIONAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-222-7755",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD002579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NutriSource, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Saint Simons Island, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.