Provider Demographics
NPI:1962742296
Name:GRIFFIN, JENNA ELIZABETH (DCN, MS, RDN, LD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ELIZABETH
Last Name:GRIFFIN
Suffix:
Gender:
Credentials:DCN, 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 1:2721 BONDS LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3175
Mailing Address - Country:US
Mailing Address - Phone:732-690-4263
Mailing Address - Fax:
Practice Address - Street 1:2721 BONDS LAKE RD NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3175
Practice Address - Country:US
Practice Address - Phone:732-690-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7157133V00000X
GALD005342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered