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General NPI Number Information
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NPI Number | 1558384248
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Entity Type | Individual
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Provider Name | BRANDI PEARCE GREEN MS, RD, LD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 96 ALI WAY CREEKSIDE SOUTH
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City | OXFORD
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State | AL
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Zip | 36203-1835
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Country | US
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Telephone | 256-832-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 703 IVEY WAY
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City | MUNFORD
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State | AL
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Zip | 36268-7104
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Country | US
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Telephone | 256-315-0546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | R872070
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License Number State |
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