MEDICARE: JANE GUO MCN, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD007162	GA
2	133V00000X	Registered Dietitian	DT88019	TX
3	133V00000X	Registered Dietitian	LD-D-10262703	OR

General Provider Information

NPI Number	:	1184349193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE GUO MCN, RD, LD

Provider Business Mailing Address
First Line	:	1801 PEACHTREE ST NE STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1895
Country	:	US
Telephone Number	:	770-756-6291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 PEACHTREE ST NE STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1895
Country	:	US
Telephone Number	:	770-756-6291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	03/16/2026

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