Provider Demographics
NPI:1588214597
Name:DENISE FIELDS, RDN, LLC
Entity Type:Organization
Organization Name:DENISE FIELDS, RDN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:229-630-3833
Mailing Address - Street 1:733 LAKE LAURIE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6421
Mailing Address - Country:US
Mailing Address - Phone:229-630-3833
Mailing Address - Fax:855-918-1019
Practice Address - Street 1:2804 N OAK ST STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5913
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty