Healthcare Provider Details

I. General information

NPI: 1457068835
Provider Name (Legal Business Name): PRECIOUS CHIAMKA EPEAGBA MS, RDN, LDN, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 BESSEMER SUPER HWY
BIRMINGHAM AL
35228-3012
US

IV. Provider business mailing address

1675 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1722
US

V. Phone/Fax

Practice location:
  • Phone: 800-881-5101
  • Fax:
Mailing address:
  • Phone: 334-294-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86169861
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: