Active NPI
Jennifer Marie Graham, MS, RDN, CSP, LD/N
- Registered Dietitian
- Valdosta, GA
National Provider Identifier
1942893136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND7159
- Practice address
- 348 Enterprise Dr Ste B
Valdosta, GA 31601-5697 - Phone
- (904) 710-8714
- NPI assigned
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | ND7159 | FL | |
| Registered Dietitian | 133V00000X | ND7159 | FL | Primary |
Addresses
Primary practice location
348 Enterprise Dr Ste B
Valdosta, GA 31601-5697
Mailing address
7789 Deer Pond LN
Tallahassee, FL 32309-9023
Phone (904) 710-8714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND7159 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1942893136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7789 DEER POND LN",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323099023",
"telephone_number": "904-710-8714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "348 ENTERPRISE DR STE B",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316015697",
"telephone_number": "904-710-8714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MS, RDN, CSP, LD/N",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-18",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "FL",
"license": "ND7159",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND7159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.