Individual
MICHELLE D BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, RDN, LD
Contact information
Practice address
4300 WARD BLUFF DR, ELLENWOOD, GA 30294-1783
(404) 216-2067
Mailing address
4300 WARD BLUFF DR, ELLENWOOD, GA 30294-1783
(404) 216-2067
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
LD002261
GA
133NN1002X
Nutrition Education Nutritionist
LD002261
GA
133V00000X
Registered Dietitian
Primary
LD002261
GA
133VN1005X
Renal Nutrition Registered Dietitian
LD00261
GA
261QC1500X
Community Health Clinic/Center
LD002261
GA
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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