Provider Demographics
NPI:1174118616
Name:WHITE, JESSICA (RD, LD, NBC-HWC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RD, LD, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 RIVER EXCHANGE DR APT 912
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4246
Mailing Address - Country:US
Mailing Address - Phone:678-499-8852
Mailing Address - Fax:
Practice Address - Street 1:3100 RIVER EXCHANGE DR APT 912
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4246
Practice Address - Country:US
Practice Address - Phone:678-499-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered