Organization
MISTY CLACKUM NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY MULLINS CLACKUM RD, CSP, LDN (OWNER)
(423) 284-5512
Entity
Organization
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
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
Other
Enumeration date
07/26/2025
Last updated
07/26/2025
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