Provider Demographics
NPI:1255359352
Name:BRAGG, SABRINA (RD, LD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ANNA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-1601
Mailing Address - Country:US
Mailing Address - Phone:256-831-3058
Mailing Address - Fax:256-835-8681
Practice Address - Street 1:1400 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-9451
Practice Address - Country:US
Practice Address - Phone:256-831-3058
Practice Address - Fax:256-835-8681
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL09454OtherBCBS UPIN#