Individual
MISS JESSICA DAVETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S, R.D, L.D
Contact information
Practice address
348 W WIEUCA RD NE, ATLANTA, GA 30342-3324
(678) 910-1458
Mailing address
348 W WIEUCA RD NE, ATLANTA, GA 30342-3324
(678) 910-1458
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD003170
GA
133VN1005X
Renal Nutrition Registered Dietitian
LD003170
GA
Other
Enumeration date
05/03/2010
Last updated
05/03/2010
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