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General NPI Number Information
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NPI Number | 1609278407
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Entity Type | Individual
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Provider Name | WILLIAM MUBANDA
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Gender | Male
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 1294 HIGHWAY 515 E
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8599
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 1294 HIGHWAY 515 E
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8599
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Country | US
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Telephone | 404-321-6111
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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 | L003748
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD002983
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License Number State | GA
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