Provider Demographics
NPI:1184171381
Name:FILEMON, JOHANE M (MS, RDN, LD, CLT)
Entity type:Individual
Prefix:MRS
First Name:JOHANE
Middle Name:M
Last Name:FILEMON
Suffix:
Gender:F
Credentials:MS, RDN, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 STONEY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6929
Mailing Address - Country:US
Mailing Address - Phone:407-616-1947
Mailing Address - Fax:
Practice Address - Street 1:1581 STONEY CHASE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6929
Practice Address - Country:US
Practice Address - Phone:407-616-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003944133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered