MEDICARE: METABOLIC EDGE NUTRITION LLC

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

General Provider Information

NPI Number	:	1952234775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METABOLIC EDGE NUTRITION LLC

Provider Business Mailing Address
First Line	:	1235 EAST BLVD STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5876
Country	:	US
Telephone Number	:	704-312-8694
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 BEARMORE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4712
Country	:	US
Telephone Number	:	704-312-8694
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNA G BUSBY
Credential	:	MS, RD, LDN, CDCES
Telephone Number	:	704-312-8694

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/08/2026

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