Provider Demographics
NPI:1164413654
Name:ANNISTON NUTRTION ASSOCIATES
Entity Type:Organization
Organization Name:ANNISTON NUTRTION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:256-831-3058
Mailing Address - Street 1:1400 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-9451
Mailing Address - Country:US
Mailing Address - Phone:256-831-3058
Mailing Address - Fax:
Practice Address - Street 1:1400 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-9451
Practice Address - Country:US
Practice Address - Phone:256-831-3058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ09698Medicare UPIN