Provider Demographics
NPI:1417557638
Name:NELSON-PORTER, BRENDA L (ND)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:NELSON-PORTER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WILSON CIR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5594
Mailing Address - Country:US
Mailing Address - Phone:770-365-7577
Mailing Address - Fax:
Practice Address - Street 1:105 WILSON CIR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5594
Practice Address - Country:US
Practice Address - Phone:770-365-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGeneticsGroup - Single Specialty
No291900000XLaboratoriesMilitary Clinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care