Provider Demographics
NPI:1366148967
Name:HIGGINBOTHAM, DAVID ALLAN (PHD, RDN, LDN)
Entity type:Individual
Prefix:MISS
First Name:DAVID
Middle Name:ALLAN
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:PHD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17355 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-4143
Mailing Address - Country:US
Mailing Address - Phone:205-200-9601
Mailing Address - Fax:
Practice Address - Street 1:17355 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-4143
Practice Address - Country:US
Practice Address - Phone:205-200-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered