Provider Demographics
NPI:1639472087
Name:MARKHAM, NATALIE GAVIN (RD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:GAVIN
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:BROOKE
Other - Last Name:GAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 E GLENWOOD DR
Mailing Address - Street 2:APT C
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3952
Mailing Address - Country:US
Mailing Address - Phone:205-835-8232
Mailing Address - Fax:
Practice Address - Street 1:3239 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2607
Practice Address - Country:US
Practice Address - Phone:205-595-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered