Healthcare Provider Details

I. General information

NPI: 1497977565
Provider Name (Legal Business Name): DANIELLE KELLEY WEBB RD, CSP, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404
US

IV. Provider business mailing address

5 LEYLAND POINTE
SAVANNAH GA
31410
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-8412
  • Fax: 912-350-8935
Mailing address:
  • Phone: 912-350-8412
  • Fax: 912-350-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD002018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: