Provider Demographics
NPI:1619857596
Name:KRAWTZ, ELYSE (RDN)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:KRAWTZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:
Other - Last Name:KRAWTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1000 JOHNSON FY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1611
Mailing Address - Country:US
Mailing Address - Phone:609-751-2221
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:609-751-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
GALD004485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered