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General NPI Number Information
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NPI Number | 1689593030
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Entity Type | Individual
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Provider Name | JANA HEITMEYER RD, CSSD, LD, CSCS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 161 SPETCHLEY WAY
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City | BOGART
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State | GA
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Zip | 30622-1797
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Country | US
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Telephone | 254-227-3614
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Fax |
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Provider Business Mailing Address
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Address Line | 3724 JEFFERSON ST STE 104
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City | AUSTIN
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State | TX
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Zip | 78731-6204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | LD004929
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License Number State | GA
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