Provider Demographics
NPI:1952172397
Name:BRASFIELD-JOHNSON, BRENDA M (RD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:BRASFIELD-JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 FAIRWAY CIR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4592
Mailing Address - Country:US
Mailing Address - Phone:229-938-2815
Mailing Address - Fax:
Practice Address - Street 1:12699 GROVE CIR
Practice Address - Street 2:
Practice Address - City:MOUNDVILLE
Practice Address - State:AL
Practice Address - Zip Code:35474-0136
Practice Address - Country:US
Practice Address - Phone:229-938-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5348133V00000X
GALD003919133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered