Healthcare Provider Details

I. General information

NPI: 1215125810
Provider Name (Legal Business Name): SANDRA VINSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 SAINT VINCENTS DR SUITE 500
BIRMINGHAM AL
35205-1684
US

IV. Provider business mailing address

806 SAINT VINCENTS DR SUITE 500
BIRMINGHAM AL
35205-1684
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1800
  • Fax: 205-930-1818
Mailing address:
  • Phone: 205-930-1800
  • Fax: 205-930-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number434596
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: