Individual
MRS. MISTY MULLINS CLACKUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CSP, LDN
Contact information
Practice address
1814 TREESORT VW, GAINESVILLE, GA 30506-5383
(423) 284-5512
(770) 470-0770
Mailing address
1814 TREESORT VW, GAINESVILLE, GA 30506-5383
(423) 284-5512
(770) 470-0770
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002340
GA
133VN1004X
Pediatric Nutrition Registered Dietitian
1250
TN
133VN1004X
Pediatric Nutrition Registered Dietitian
LD002340
GA
133VN1401X
Pediatric Critical Care Nutrition Registered Dietitian
LD002340
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q038482
—
TN
Enumeration date
12/11/2013
Last updated
07/26/2025
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