Healthcare Provider Details

I. General information

NPI: 1902712664
Provider Name (Legal Business Name): AMY YEPIFANTSEV RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EPPS BRIDGE PKWY APT 414
ATHENS GA
30606-8321
US

IV. Provider business mailing address

250 EPPS BRIDGE PKWY APT 414
ATHENS GA
30606-8321
US

V. Phone/Fax

Practice location:
  • Phone: 770-549-4387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD009426
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: