Provider Demographics
NPI:1538775960
Name:BROWN, LAURA LANE (MBA, MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MBA, MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 CHASTAIN PARK CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3235
Mailing Address - Country:US
Mailing Address - Phone:615-653-3667
Mailing Address - Fax:
Practice Address - Street 1:2042 CHASTAIN PARK CT NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3235
Practice Address - Country:US
Practice Address - Phone:615-653-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered