Provider Demographics
NPI:1679683015
Name:BRUMFIELD, IRENE LEWIS (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:LEWIS
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:IRENE
Other - Middle Name:SHARON
Other - Last Name:BRUMFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3636 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3338
Mailing Address - Country:US
Mailing Address - Phone:404-403-3035
Mailing Address - Fax:
Practice Address - Street 1:2669 CHURCH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3115
Practice Address - Country:US
Practice Address - Phone:404-209-0113
Practice Address - Fax:404-209-0285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered