Provider Demographics
NPI:1427294420
Name:NEAL, JATUN KREATSON (MFCS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JATUN
Middle Name:KREATSON
Last Name:NEAL
Suffix:
Gender:F
Credentials:MFCS, RD, LD
Other - Prefix:MS
Other - First Name:JATUN
Other - Middle Name:KREATSON
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFCS, RD, LD
Mailing Address - Street 1:4178 GRANT FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-5505
Mailing Address - Country:US
Mailing Address - Phone:404-285-7275
Mailing Address - Fax:
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-417-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered