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General NPI Number Information
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NPI Number | 1366122293
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Entity Type | Individual
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Provider Name | JEREMY DOUGLAS RDN
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Gender | Male
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 1380 W MARIETTA ST NW
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City | ATLANTA
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State | GA
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Zip | 30318-4974
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Country | US
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Telephone | 614-738-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 4104 PEACHFORD CIR
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City | DUNWOODY
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State | GA
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Zip | 30338-6488
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD006597
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License Number State | GA
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