Healthcare Provider Details

I. General information

NPI: 1801301023
Provider Name (Legal Business Name): MICHELLE C JEFFCOAT MS,RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 RIDGEMONT DR
BIRMINGHAM AL
35244-1228
US

IV. Provider business mailing address

2503 RIDGEMONT DR
BIRMINGHAM AL
35244-1228
US

V. Phone/Fax

Practice location:
  • Phone: 205-999-1701
  • Fax:
Mailing address:
  • Phone: 205-999-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1758
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1758
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: