MEDICARE: MRS. BRANDI PEARCE GREEN MS, RD, LD

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	R872070

General Provider Information

NPI Number	:	1558384248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI PEARCE GREEN MS, RD, LD

Provider Business Mailing Address
First Line	:	703 IVEY WAY
Second Line	:
City	:	MUNFORD
State	:	AL
Zip	:	36268-7104
Country	:	US
Telephone Number	:	256-315-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 ALI WAY
Second Line	:	CREEKSIDE SOUTH
City	:	OXFORD
State	:	AL
Zip	:	36203-1835
Country	:	US
Telephone Number	:	256-832-4141
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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