Provider Demographics
NPI:1740889781
Name:BROWN, GEORGIA ELIZABETH (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20770 EMPIRE AVE APT 140
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5000
Mailing Address - Country:US
Mailing Address - Phone:650-218-9702
Mailing Address - Fax:
Practice Address - Street 1:2200 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6063
Practice Address - Country:US
Practice Address - Phone:541-389-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10209301133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric