MEDICARE: LAUREN ELLIS BUSBY 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

General Provider Information

NPI Number	:	1992652952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELLIS BUSBY RD

Provider Business Mailing Address
First Line	:	102 MILL CREST DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5304
Country	:	US
Telephone Number	:	205-936-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MILL CREST DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5304
Country	:	US
Telephone Number	:	205-936-1492
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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