MEDICARE: MRS. JOHANE M FILEMON MS, RDN, LD, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	12887.	FL
2	133V00000X	Registered Dietitian	562429	WI
3	133V00000X	Registered Dietitian	LD003944	GA
4	133V00000X	Registered Dietitian	164.010261	IL

General Provider Information

NPI Number	:	1184171381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHANE M FILEMON MS, RDN, LD, CLT

Provider Business Mailing Address
First Line	:	35 PATTERSON RD # 465942
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4717
Country	:	US
Telephone Number	:	407-616-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 PATTERSON RD # 465942
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4717
Country	:	US
Telephone Number	:	770-904-9154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	12/22/2025

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