MEDICARE: JENY THATIL MS, 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	LD003343	GA
2	133VN1004X	Pediatric Nutrition Registered Dietitian	LD003343	GA
3	133VN1005X	Renal Nutrition Registered Dietitian	LD003343	GA
4	133VN1006X	Metabolic Nutrition Registered Dietitian	LD003343	GA

General Provider Information

NPI Number	:	1821369372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENY THATIL MS, RD, LD

Provider Business Mailing Address
First Line	:	10 PERIMETER SUMMIT BLVD NE
Second Line	:	UNIT 4101
City	:	ATLANTA
State	:	GA
Zip	:	30319-1429
Country	:	US
Telephone Number	:	404-590-5369
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PERIMETER SUMMIT BLVD NE
Second Line	:	UNIT 4101
City	:	ATLANTA
State	:	GA
Zip	:	30319-1429
Country	:	US
Telephone Number	:	404-590-5369
Fax Number	:

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

Provider Enumeration Date	:	01/14/2012
Last Update Date	:	01/14/2012

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