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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | Q038482 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
4980 Alpha Ln, Hixson, TN 373435470 | 4239549010 | 4233080277 |
60 Pointe Willow Dr, Cleveland, GA 305287722 | 4232845512 |
Street Address |
1208 SHERWOOD PARK DR NE STE A |
City | GAINESVILLE |
State | GA |
Zip Code | 30501-3445 |
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 |
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 Code | 133VN1004X |
Grouping | Dietary & Nutritional Service Providers |
Classification | Dietitian, Registered |
Specialization | Nutrition, Pediatric |
Definition to come... |
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 |
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 |
City | GAINESVILLE |
Zip Code | 30501 |
Please comment or provide details below to improve the information on MRS. MISTY MULLINS CLACKUM.
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.