MEDICARE: MRS. MARY ELIZABETH MEADOWS RD

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	2365	AL

General Provider Information

NPI Number	:	1992189575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELIZABETH MEADOWS RD

Provider Business Mailing Address
First Line	:	1990 GAULT AVE N STE 200
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3418
Country	:	US
Telephone Number	:	256-997-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 GAULT AVE N STE 200
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3418
Country	:	US
Telephone Number	:	256-997-9200
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/14/2015

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