Provider Demographics
NPI:1013994433
Name:BRANNON, GARREN MARK (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:GARREN
Middle Name:MARK
Last Name:BRANNON
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 NAVAJO AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5437
Mailing Address - Country:US
Mailing Address - Phone:336-414-5686
Mailing Address - Fax:
Practice Address - Street 1:2899 NAVAJO AVE
Practice Address - Street 2:EVERY BITE COUNTS/MAKE EVERY BITE COUNT
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5437
Practice Address - Country:US
Practice Address - Phone:336-414-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered