Provider Demographics
NPI:1467203786
Name:BAMBERG, LEIGH-ANN GARDNER (MS, RDN, LD, CEDS-S)
Entity Type:Individual
Prefix:
First Name:LEIGH-ANN
Middle Name:GARDNER
Last Name:BAMBERG
Suffix:
Gender:F
Credentials:MS, RDN, LD, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 NORWICK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8403
Mailing Address - Country:US
Mailing Address - Phone:334-412-0917
Mailing Address - Fax:
Practice Address - Street 1:236 NORWICK FOREST DR
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8403
Practice Address - Country:US
Practice Address - Phone:334-412-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered