Provider Demographics
NPI:1417596347
Name:GEORGE, JENNIFER JOY (RDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5531
Mailing Address - Country:US
Mailing Address - Phone:410-603-0650
Mailing Address - Fax:
Practice Address - Street 1:200 E VINE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5531
Practice Address - Country:US
Practice Address - Phone:443-358-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4807