Provider Demographics
NPI:1831322742
Name:BYRD, FREIDA ANN (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:FREIDA
Middle Name:ANN
Last Name:BYRD
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MRS
Other - First Name:FREIDA
Other - Middle Name:ANN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LD
Mailing Address - Street 1:2896 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-0058
Mailing Address - Country:US
Mailing Address - Phone:912-283-7905
Mailing Address - Fax:
Practice Address - Street 1:2896 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-0058
Practice Address - Country:US
Practice Address - Phone:912-283-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered