Provider Demographics
NPI:1831930221
Name:DRISS, DEANNA G (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:G
Last Name:DRISS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S LAMAR BLVD STE NW1350
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5373
Mailing Address - Country:US
Mailing Address - Phone:662-915-8662
Mailing Address - Fax:
Practice Address - Street 1:2301 S LAMAR BLVD STE NW1350
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5373
Practice Address - Country:US
Practice Address - Phone:662-915-8662
Practice Address - Fax:662-915-8663
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD2418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered