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1538868120 NPI number — CICELY D THOMAS DCN.M.ED.RDN.LD

NPI Number: 1538868120
Health Care Provider/Practitioner: CICELY D THOMAS DCN.M.ED.RDN.LD

Information about “1538868120” NPI (CICELY D THOMAS DCN.M.ED.RDN.LD) exists in 1538868120 in HTML format HTML  |  1538868120 in plain Text format TXT  |  1538868120 in PDF (Portable Document Format) PDF  |  1538868120 in an XML format XML  formats.

NPI Number : 1538868120 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538868120",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THOMAS",
    "FirstName": "CICELY",
    "MiddleName": "D",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "DCN.M.ED.RDN.LD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "20 CANTRELL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARTERSVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30120-2570",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20 CANTRELL ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARTERSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30120-2570",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-316-6365",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2023",
    "LastUpdateDate": "03/02/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133NN1002X",
          "TaxonomyName": "Nutrition Education Nutritionist",
          "LicenseNumber": "LD002857",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133VN1201X",
          "TaxonomyName": "Obesity and Weight Management Nutrition Registered Dietitian",
          "LicenseNumber": "LD002857",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "LD002857",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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