Active NPI
Michael Vincent Polis, REGISTERED DIETITIAN
- Registered Dietitian
- Fort Moore, GA
National Provider Identifier
1972951614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2254
- Practice address
- Martin Army 6600
9250
Fort Moore, GA 31905 - Phone
- (762) 408-2033
- NPI assigned
- Jun 2, 2016
- Sex
- Male
- 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 | 2254 | AL | Primary |
Addresses
Primary practice location
Martin Army 6600
9250
Fort Moore, GA 31905
Mailing address
Martin Army 6600 Van Aalst Blvd
BLD 9250
For Moore, GA 31905
Phone (762) 408-1190
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 |
|---|---|---|---|
| 2254 | AL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713398400000",
"number": "1972951614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MARTIN ARMY 6600 VAN AALST BLVD",
"address_2": "BLD 9250",
"city": "FOR MOORE",
"state": "GA",
"postal_code": "31905",
"telephone_number": "762-408-1190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MARTIN ARMY 6600",
"address_2": "9250",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "31905",
"telephone_number": "762-408-2033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIS",
"first_name": "MICHAEL",
"middle_name": "VINCENT",
"credential": "REGISTERED DIETITIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-02",
"last_updated": "2024-04-18",
"certification_date": "2024-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AL",
"license": "2254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Moore, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.