Provider Demographics
NPI:1649923129
Name:DEGARIS, COURTNEY ANDERSON (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ANDERSON
Last Name:DEGARIS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 ARLINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4113
Mailing Address - Country:US
Mailing Address - Phone:205-933-0041
Mailing Address - Fax:
Practice Address - Street 1:2401 ARLINGTON AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4113
Practice Address - Country:US
Practice Address - Phone:205-933-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4016133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological