=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952022303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORA MCDEVITT JOHNSON RDN, LDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2022
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 912 N ELM ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-455-2358
-----------------------------------------------------
Fax | 336-290-5407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4110 BRYNWOOD DR
-----------------------------------------------------
City | COLFAX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27235-9706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-710-5416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | L006912
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------