Healthcare Provider Details

I. General information

NPI: 1659623502
Provider Name (Legal Business Name): DANA LEAH GREEAR MS, RD, LD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA GREEAR RD, LD

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST SUITE 10 POB 3
AUGUSTA GA
30901-2700
US

IV. Provider business mailing address

811 13TH ST STE 10
AUGUSTA GA
30901-2771
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-1590
  • Fax: 803-279-6001
Mailing address:
  • Phone: 706-434-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: