Provider Demographics
NPI:1538419007
Name:DUNSTAN, JOHANNA M (RD, LD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:M
Last Name:DUNSTAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BUXTON LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8400
Mailing Address - Country:US
Mailing Address - Phone:706-814-3959
Mailing Address - Fax:
Practice Address - Street 1:304 BUXTON LN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8400
Practice Address - Country:US
Practice Address - Phone:706-814-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered