Provider Demographics
NPI:1467990796
Name:JOHNSON, EMMA A (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 LOROPETALUM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7879
Mailing Address - Country:US
Mailing Address - Phone:919-452-3979
Mailing Address - Fax:
Practice Address - Street 1:1615 LOROPETALUM RD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7879
Practice Address - Country:US
Practice Address - Phone:919-452-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered