Provider Demographics
NPI:1659623502
Name:GREEAR, DANA LEAH (MS, RD, LD, MPH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LEAH
Last Name:GREEAR
Suffix:
Gender:F
Credentials:MS, RD, LD, MPH
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:GREEAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:811 13TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2771
Mailing Address - Country:US
Mailing Address - Phone:706-434-1590
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:SUITE 10 POB 3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2700
Practice Address - Country:US
Practice Address - Phone:706-434-1590
Practice Address - Fax:803-279-6001
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered