Healthcare Provider Details

I. General information

NPI: 1013994433
Provider Name (Legal Business Name): GARREN MARK BRANNON RDN, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 NAVAJO AVE EVERY BITE COUNTS/MAKE EVERY BITE COUNT
WINSTON SALEM NC
27103-5437
US

IV. Provider business mailing address

2899 NAVAJO AVE
WINSTON-SALEM NC
27103-5437
US

V. Phone/Fax

Practice location:
  • Phone: 336-414-5686
  • Fax:
Mailing address:
  • Phone: 336-414-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: