MEDICARE: MS. DENISE K. FIELDS LICENSED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD003359	GA

General Provider Information

NPI Number	:	1033343785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE K. FIELDS LICENSED DIETITIAN

Provider Business Mailing Address
First Line	:	733 LAKE LAURIE DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-6421
Country	:	US
Telephone Number	:	229-630-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	733 LAKE LAURIE DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-6421
Country	:	US
Telephone Number	:	229-630-3833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	08/13/2019

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