Provider Demographics
NPI:1487398368
Name:CHAVIS, LEANNE KING (RD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:KING
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:919-681-4033
Mailing Address - Fax:
Practice Address - Street 1:1103 N ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6312
Practice Address - Country:US
Practice Address - Phone:336-272-6161
Practice Address - Fax:336-271-3724
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered