Provider Demographics
NPI:1437370434
Name:COFFEE, BRANDY ELISHER (RD LD)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:ELISHER
Last Name:COFFEE
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PYRON PT
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2363
Mailing Address - Country:US
Mailing Address - Phone:404-915-3348
Mailing Address - Fax:
Practice Address - Street 1:1631 CALLAWAY LOOP
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3672
Practice Address - Country:US
Practice Address - Phone:404-957-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157648133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education