YOUR DIETITIAN LLC NPI 1609104058

NPI Information

  • NPI: 1609104058
  • Provider Name: YOUR DIETITIAN LLC
  • Classification: Dietitian, Registered - 133VN1005X
  • Specialization: Nutrition, Renal
  • Entity Type: Organization
  • Address: 2758 FELTON DR
    EAST POINT, GA
    ZIP 30344
  • Phone: (770) 356-9468

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NPI Details

YOUR DIETITIAN LLC is a nutrition and renal dietitian registered in East Point, GA. The provider is an individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury, chronic kidney disease (CKD) stages 1-5, or receiving renal replacement therapies (dialysis/transplant) in a variety of settings, OR works indirectly in management, education, or research practice linked specifically to renal nutrition. The specialist in renal/nephrology nutrition is responsible for nutrition assessment, diagnosis, intervention, monitoring, and evaluation. YOUR DIETITIAN LLC NPI is 1609104058. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2758 FELTON DR
EAST POINT, GA
ZIP 30344-604
Phone: (770) 356-9468
Fax: (678) 547-3156

The provider's authorized official is Genevieve Broomfield .
The authorized official title is Chief Operating Officer and has the following contact phone number (770) 356-9468.

The enumeration date for this NPI number is 11/23/2009 and was last updated on 11/23/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1133V00000XDietitian, RegisteredLD001151GEORGIANo
2133VN1006XDietitian, RegisteredNutrition, MetabolicLD001151GEORGIANo
3133VN1005XDietitian, RegisteredNutrition, RenalLD001151GEORGIAYes

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This page was last updated on: 11/21/2025

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