Healthcare Provider Details

I. General information

NPI: 1689593030
Provider Name (Legal Business Name): JANA HEITMEYER RD, CSSD, LD, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SPETCHLEY WAY
BOGART GA
30622-1797
US

IV. Provider business mailing address

3724 JEFFERSON ST STE 104
AUSTIN TX
78731-6204
US

V. Phone/Fax

Practice location:
  • Phone: 254-227-3614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberLD004929
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: