Provider Demographics
NPI:1699451021
Name:BROWN, DONNA VELLA (RDN,LD)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:VELLA
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 E END RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-4053
Mailing Address - Country:US
Mailing Address - Phone:404-791-5755
Mailing Address - Fax:
Practice Address - Street 1:10155 EAGLE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3805
Practice Address - Country:US
Practice Address - Phone:770-385-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA655641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered