Active NPI
Jeremy Douglas, RDN
- Registered Dietitian
- Atlanta, GA
National Provider Identifier
1366122293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD006597
- Practice address
- 1380 W Marietta St NW
Atlanta, GA 30318-4974 - Phone
- (614) 738-1343
- NPI assigned
- Jul 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD006597 | GA | Primary |
Addresses
Primary practice location
1380 W Marietta St NW
Atlanta, GA 30318-4974
Mailing address
4104 Peachford Cir
Dunwoody, GA 30338-6488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 18, 2025 through Sep 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD006597 | GA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768089600000",
"number": "1366122293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4104 PEACHFORD CIR",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303386488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1380 W MARIETTA ST NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303184974",
"telephone_number": "614-738-1343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "JEREMY",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-25",
"last_updated": "2026-01-11",
"certification_date": "2026-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "GA",
"license": "LD006597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.