Provider Demographics
NPI:1508957077
Name:GREENWOOD, ROSEMARY VIOLA (MPA, RD)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:VIOLA
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:MPA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6053
Mailing Address - Country:US
Mailing Address - Phone:601-981-2663
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-368-4483
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
840107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered