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Contact Information

MICHELLE D BROUSSARD, PHD, RDN, LD
4300 WARD BLUFF DR
ELLENWOOD, GA30294-1783
 Phone: 404-216-2067
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Community Health

261QC1500X
 

Dietary Manager

132700000X
 

Nutrition, Education

133NN1002X
 

Nutrition, Renal

133VN1005X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for MICHELLE D BROUSSARD · (Female)

NPI # 1689551053
Status Active
Credentials PHD, RDN, LD
Entity Individual
Enumeration date 08/18/2025
Last updated 08/18/2025 - About 10 months ago
Sole proprietor 1 Yes
Identifiers
  • GA License # LD002261
  • GA License # LD00261
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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