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General NPI Number Information
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NPI Number | 1952172397
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Entity Type | Individual
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Provider Name | BRENDA M BRASFIELD-JOHNSON RD
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 12699 GROVE CIR
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City | MOUNDVILLE
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State | AL
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Zip | 35474-0136
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Country | US
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Telephone | 229-938-2815
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Fax |
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Provider Business Mailing Address
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Address Line | 243 FAIRWAY CIR
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City | AMERICUS
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State | GA
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Zip | 31709-4592
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Country | US
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Telephone | 229-938-2815
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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 | 5348
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | LD003919
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License Number State | GA
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