Provider Demographics
NPI:1437419678
Name:PRINCE-FARMER, JENNA LEE (RD , LD)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEE
Last Name:PRINCE-FARMER
Suffix:
Gender:F
Credentials:RD , LD
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LEE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD , LD
Mailing Address - Street 1:1302 UPPER GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-2744
Mailing Address - Country:US
Mailing Address - Phone:770-893-7115
Mailing Address - Fax:
Practice Address - Street 1:758 UPPER GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-2750
Practice Address - Country:US
Practice Address - Phone:770-893-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003218133V00000X
IL164.010910133V00000X
GALD003971133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered