Provider Demographics
NPI:1417197823
Name:FREDIANI, JENNIFER KOREN (RD, LD, ACSM-CES)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KOREN
Last Name:FREDIANI
Suffix:
Gender:F
Credentials:RD, LD, ACSM-CES
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, ACSM-CES
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:SUITE GG-23
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-712-7239
Mailing Address - Fax:404-727-5563
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:SUITE GG-23
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-7239
Practice Address - Fax:404-727-5563
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered