Provider Demographics
NPI:1568109676
Name:THURMAN, JAYLA DANIELLE (RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:JAYLA
Middle Name:DANIELLE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 COVINGTON BRIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:GA
Mailing Address - Zip Code:30139-2094
Mailing Address - Country:US
Mailing Address - Phone:770-324-9855
Mailing Address - Fax:
Practice Address - Street 1:600 CELEBRATE LIFE PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8001
Practice Address - Country:US
Practice Address - Phone:470-241-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006229133VN1301X
GA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133N00000XDietary & Nutritional Service ProvidersNutritionist