Provider Demographics
NPI:1558384248
Name:GREEN, BRANDI PEARCE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:PEARCE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 IVEY WAY
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36268-7104
Mailing Address - Country:US
Mailing Address - Phone:256-315-0546
Mailing Address - Fax:
Practice Address - Street 1:96 ALI WAY
Practice Address - Street 2:CREEKSIDE SOUTH
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1835
Practice Address - Country:US
Practice Address - Phone:256-832-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R872070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered