Provider Demographics
NPI:1558855700
Name:PRICE, JENNIFER (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MORTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5021
Mailing Address - Country:US
Mailing Address - Phone:706-201-6997
Mailing Address - Fax:
Practice Address - Street 1:1026 TWELVE OAKS DR.
Practice Address - Street 2:SUITE A
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7254
Practice Address - Country:US
Practice Address - Phone:706-201-6997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered