Healthcare Provider Details

I. General information

NPI: 1417596347
Provider Name (Legal Business Name): JENNIFER JOY GEORGE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E VINE ST
SALISBURY MD
21804-5531
US

IV. Provider business mailing address

200 E VINE ST
SALISBURY MD
21804-5531
US

V. Phone/Fax

Practice location:
  • Phone: 443-358-6445
  • Fax:
Mailing address:
  • Phone: 410-603-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDX4807
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: