Healthcare Provider Details

I. General information

NPI: 1356865844
Provider Name (Legal Business Name): BRENDA VERONIQUE LEMOINE RD,LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/21/2022
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 S FULTON AVENUE SUITE 1150
ATLANTA GA
30354-5759
US

IV. Provider business mailing address

3640 S FULTON AVE SUITE 1150
ATLANTA GA
30354-1703
US

V. Phone/Fax

Practice location:
  • Phone: 903-748-9742
  • Fax:
Mailing address:
  • Phone: 470-812-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD004920
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD004920
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD004920
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004920
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: