Healthcare Provider Details

I. General information

NPI: 1689104572
Provider Name (Legal Business Name): ANNA GRACE BUSBY MS, RD, LDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 BEARMORE DR
CHARLOTTE NC
28211-4712
US

IV. Provider business mailing address

1235 EAST BLVD STE E #1934
CHARLOTTE NC
28203-5876
US

V. Phone/Fax

Practice location:
  • Phone: 704-312-8694
  • Fax:
Mailing address:
  • Phone: 850-322-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006822
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: