1740411776 NPI number — GENEVIEVE E BROOMFIELD R.D, L.D., C.S.R.

NPI Number: 1740411776
Health Care Provider/Practitioner: GENEVIEVE E BROOMFIELD R.D, L.D., C.S.R.

NPI Number : 1740411776 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740411776",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROOMFIELD",
    "FirstName": "GENEVIEVE",
    "MiddleName": "E",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "R.D, L.D., C.S.R.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "908 NEEDLETOP CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCDONOUGH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30253-4315",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-356-9468",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2758 FELTON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAST POINT",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30344-3604",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-356-9468",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/07/2009",
    "LastUpdateDate": "08/07/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "LD001151",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133VN1005X",
          "TaxonomyName": "Renal Nutrition Registered Dietitian",
          "LicenseNumber": "LD001151",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}