Provider Demographics
NPI:1962742296
Name:GRIFFIN, JENNA ELIZABETH (DCN, RDN, LD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ELIZABETH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DCN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 INTERSTATE NORTH CIR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2384
Mailing Address - Country:US
Mailing Address - Phone:732-690-4263
Mailing Address - Fax:
Practice Address - Street 1:3100 INTERSTATE NORTH CIR SE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2384
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:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7157133V00000X
GALD005342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered