Provider Demographics
NPI:1780338988
Name:BROWN, KELSEY (RDN, LD, CLC)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 GRAND CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-4787
Mailing Address - Country:US
Mailing Address - Phone:706-208-7451
Mailing Address - Fax:
Practice Address - Street 1:1601 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2489
Practice Address - Country:US
Practice Address - Phone:229-924-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered