Provider Demographics
NPI:1457554206
Name:DANIEL, TENA D (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:TENA
Middle Name:D
Last Name:DANIEL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DOUGLAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549
Mailing Address - Country:US
Mailing Address - Phone:706-340-0327
Mailing Address - Fax:
Practice Address - Street 1:2180 OCONEE CONNECTOR
Practice Address - Street 2:STE 105
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5715
Practice Address - Country:US
Practice Address - Phone:706-389-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA810862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I717050Medicare PIN