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General NPI Number Information
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NPI Number | 1437419678
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Entity Type | Individual
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Provider Name | JENNA LEE PRINCE-FARMER R.D. , L.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 758 UPPER GRANDVIEW RD
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City | JASPER
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State | GA
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Zip | 30143-2750
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Country | US
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Telephone | 770-893-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 UPPER GRANDVIEW RD
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City | JASPER
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State | GA
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Zip | 30143-2744
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Country | US
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Telephone | 770-893-7115
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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 | L003218
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.010910
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD003971
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License Number State | GA
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