Provider Demographics
NPI:1184349193
Name:GUO, JANE (MCN, RD, LD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:MCN, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 THORNCREST CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8453
Mailing Address - Country:US
Mailing Address - Phone:404-376-5086
Mailing Address - Fax:
Practice Address - Street 1:87 THORNCREST CT
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8453
Practice Address - Country:US
Practice Address - Phone:404-376-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered