Provider Demographics
NPI:1033404371
Name:SANIATAN, JAYMAR (RD)
Entity Type:Individual
Prefix:
First Name:JAYMAR
Middle Name:
Last Name:SANIATAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 NOTTOWAY TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7811
Mailing Address - Country:US
Mailing Address - Phone:818-481-4543
Mailing Address - Fax:
Practice Address - Street 1:1251 NOTTOWAY TRL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7811
Practice Address - Country:US
Practice Address - Phone:818-481-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA896576133V00000X, 133VN1004X, 133VN1006X
GA896576133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic