Provider Demographics
NPI:1821369372
Name:THATIL, JENY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JENY
Middle Name:
Last Name:THATIL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PERIMETER SUMMIT BLVD NE
Mailing Address - Street 2:UNIT 4101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1429
Mailing Address - Country:US
Mailing Address - Phone:404-590-5369
Mailing Address - Fax:
Practice Address - Street 1:10 PERIMETER SUMMIT BLVD NE
Practice Address - Street 2:UNIT 4101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1429
Practice Address - Country:US
Practice Address - Phone:404-590-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003343133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic