Provider Demographics
NPI:1346137569
Name:MCCORMICK, ANGELA B (MS,RD,LD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:MCCORMICK
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 1:3186 PARLIAMENT CIR STE 902
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7271
Mailing Address - Country:US
Mailing Address - Phone:334-416-8298
Mailing Address - Fax:833-260-4473
Practice Address - Street 1:3186 PARLIAMENT CIR STE 9023186
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7271
Practice Address - Country:US
Practice Address - Phone:334-416-8298
Practice Address - Fax:833-260-4473
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1087950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty