Provider Demographics
NPI:1336782713
Name:KOELLNER, JENNA (RD, LD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KOELLNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SMOKE RISE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6250
Mailing Address - Country:US
Mailing Address - Phone:330-690-9930
Mailing Address - Fax:
Practice Address - Street 1:35 BARNARD ST STE 318
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2500
Practice Address - Country:US
Practice Address - Phone:912-353-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered