Provider Demographics
NPI:1467050716
Name:BROWN, LOUISE (MPH, RD, LD, CDCES)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MPH, RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5607
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:165 BLUE RIDGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4431
Practice Address - Country:US
Practice Address - Phone:706-946-4647
Practice Address - Fax:706-374-5006
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001543133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003257662Medicaid
TNQ076485Medicaid