Clackum, Misty Mullins

Clackum, Misty Mullins is an sole proprietor health care provider with primary practice located at 3869 Berkshire Ridge Dr , Gainesville GA 30506-4560. She recently has 2 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Dietary & Nutritional Service Providers / Nutrition, Pediatric. Dietary & Nutritional Service Providers / Nutrition, Pediatric is her primary health care specialty. Clackum, Misty Mullins can be contacted via phone (423) 284-5512.

Contact Information

Primary practice address
3869 Berkshire Ridge Dr Gainesville GA 30506-4560
Phone: (423) 284-5512
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X LD002340 Georgia
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X 1250 Tennessee
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X LD002340 Georgia

Profile Details

NPI number 1073944492
LBN Legal business name Clackum, Misty Mullins
Credentials RD, CSP, LDN
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 11th, 2013
Last updated Jun 6th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073944492 NPPES
Tennessee MEDICAID Q038482

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