Healthcare Provider Details

I. General information

NPI: 1982771788
Provider Name (Legal Business Name): GEORGEANN M FISHER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14392 BROADWINGED DR
GAINESVILLE VA
20155-5928
US

IV. Provider business mailing address

14392 BROADWINGED DR
GAINESVILLE VA
20155-5928
US

V. Phone/Fax

Practice location:
  • Phone: 301-491-1402
  • Fax: 301-491-1402
Mailing address:
  • Phone: 301-491-1402
  • Fax: 301-491-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDT89532
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT89532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: