MRS. MISTY MULLINS CLACKUM


Address: 1208 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3445
Phone: 4237744690

MRS. MISTY MULLINS CLACKUM (NPI# 1073944492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073944492
Entity Type Individual
Full Name MRS. MISTY MULLINS CLACKUM
Other Name MISTY LEHE MULLINS
Credential RD, CSP, LDN
Practice Address 1208 Sherwood Park Dr Ne Ste A
Gainesville
GA 30501-3445
Mailing Address 60 Pointe Willow Dr
Cleveland
GA 30528-7722
Practice Telephone 4237744690
Mailing Telephone 4232845512
Enumeration Date 2013-12-11
Last Update Date 2020-08-27
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 133V00000X Dietitian, Registered LD002340 GA Dietary & Nutritional Service Providers
Y 133VN1004X Dietitian, Registered
Specialization: Nutrition, Pediatric
LD002340 GA Dietary & Nutritional Service Providers
N 133VN1004X Dietitian, Registered
Specialization: Nutrition, Pediatric
1250 TN Dietary & Nutritional Service Providers
N 133VN1401X LD002340 GA

Other Provider Identifier

State Issuer Identifier Type Code
TN Q038482 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
4980 Alpha Ln, Hixson, TN 373435470 4239549010 4233080277
60 Pointe Willow Dr, Cleveland, GA 305287722 4232845512

Office Location

Street Address 1208 SHERWOOD PARK DR NE STE A
City GAINESVILLE
State GA
Zip Code 30501-3445

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255599973 Ritu Walia Pediatrics 1208 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3445 2008-05-29
1114565090 Gastro Health for Kids Incorporated Pediatrics 1208 Sherwood Park Dr Ne Ste A, Gainesville, GA 30501-3445 2019-12-11

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437782851 Madison Raye Huth Physician Assistant 743 Spring Street Se, Gainesville, GA 30501 2020-02-13
1205487659 Grace M Walker Brown Nurse Practitioner 592 Medical Park Dr., Suite A, Gainesville, GA 30501 2019-09-26
1174086987 Nayab Ahmed Student in an Organized Health Care Education/Training Program 743 Spring Street, Suite 710, Gainesville, GA 30501 2019-04-09
1154881118 Ryan D Berry Student in an Organized Health Care Education/Training Program 734 Spring St Se Ste 710, Gainesville, GA 30501 2019-03-24
1609336304 Harper E Niver Student in an Organized Health Care Education/Training Program 743 Spring St., Suite 710, Gainesville, GA 30501 2019-03-20
1508336173 Bradee Burrell Aderholt Nurse Practitioner 663 Lanier Park Drive, Gainesville, GA 30501 2018-11-27
1578068359 Soammy Liz Matias Chiropractor 961 Green Street, Gainesville, GA 30501 2018-03-26
1811496896 Matthew Brown Speech-Language Pathologist 500 Spring St. Se Suite 101, Gainesville, GA 30501 2018-02-06
1346769825 Dr. Skeete & Associates of North Georgia, P.C. Optometrist 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 2017-09-15
1932624723 M & B Imaging, PC Radiology 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 2017-08-14
Find all providers in zip 30501

Taxonomy Information

Taxonomy Code 133VN1004X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered
Specialization Nutrition, Pediatric

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1235430703 Jennifer Hillan Dietitian, Registered 2000 Sw Archer Rd, Gainesville, FL 32608-1136 2010-11-15
1952525321 Hans M Hammer Dietitian, Registered 1280 Athens St, Gainesville, GA 30507-7000 2007-04-13

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1629603691 Meredith Leigh Johnson Dietitian, Registered 1400 Tullie Rd Ne # 8221b, Atlanta, GA 30329-2309 2020-03-10
1811546211 April Lynn Dehetre Perkins Dietitian, Registered 4 N Quail Xing, Savannah, GA 31419-1244 2019-09-09
1407373905 Chelsea Hrovat Dietitian, Registered 1690 Stone Village Ln Nw Ste 322, Kennesaw, GA 30152-7778 2017-08-25
1285058446 Jeanne Baker Mcdaniel Dietitian, Registered 289 Dartmoor Cir, Sandy Springs, GA 30328-1902 2014-02-09
1992004519 Karen Alicia Baldree Dietitian, Registered 122 Oakwood Ct, Tifton, GA 31793-5755 2011-03-22
1720156110 Laura Lee Davis Dietitian, Registered 1640 Powers Ferry Road, Suite 100, Building 9, Marietta, GA 30067-5491 2006-12-01
1770104283 Sierra Jacquelynn Wineinger Dietitian, Registered 1446 Harper St, Augusta, GA 30912-0012 2020-05-06
1144862749 Victoria Baird Dietitian, Registered 1400 Tullie Rd Ne, Atlanta, GA 30329-2309 2019-10-15
1659855765 Lydia Delbridge White Dietitian, Registered 1920 Briarcliff Rd Ne, Atlanta, GA 30329-4010 2018-09-25
1053866970 Nourishing Nutrition Consulting LLC Dietitian, Registered 14 Eastbrook Bnd, Suite 212, Peachtree City, GA 30269-1530 2016-08-20
Find all providers with the same taxonomy

Competitor

Search similar providers

City GAINESVILLE
Zip Code 30501

Improve Information

Please comment or provide details below to improve the information on MRS. MISTY MULLINS CLACKUM.

Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

Trending Searches