Individual
MRS. AUDREY EDWARDS BRANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD. LD. MSA, DMIN
Contact information
Practice address
1 FREEDOM WAY, 296 U, AUGUSTA, GA 30904
(706) 733-0188
Mailing address
1 FREEDOM WAY, 296 U, AUGUSTA, GA 30904
(706) 733-0188
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
725487
CDR, RD REGISTRATION NUM
GA
01
—
LD002235
GA LICENSURE
GA
Enumeration date
10/04/2006
Last updated
07/01/2015
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