JEREMY DOUGLAS RDN
NPI 1366122293
Dietitian, Registered in Atlanta, GA
NPI Status: Active since July 25, 2023
Contact Information
1380 W MARIETTA ST NW
ATLANTA, GA
ZIP 30318
Phone: (614) 738-1343
- Individual
- Male
- Dietitian, Registered
- Opted-Out Medicare
About JEREMY DOUGLAS
This page provides the complete NPI Profile along with additional information for Jeremy Douglas, a provider established in Atlanta, Georgia with a medical specialization in Dietitian, Registered. The healthcare provider is registered in the NPI registry with number 1366122293 assigned on July 2023. The practitioner's primary taxonomy code is 133V00000X with license number LD006597 (GA). The provider is registered as an individual and his NPI record was last updated January 2026.
- NPI
- 1366122293
- Provider Name
- JEREMY DOUGLAS RDN
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1380 W MARIETTA ST NW ATLANTA, GA 30318
- Location Phone
- (614) 738-1343
- Mailing Address
- 4104 PEACHFORD CIR DUNWOODY, GA 30338
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 07-25-2023
- Last Update Date
- 01-11-2026
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Jeremy Douglas opted out of Medicare effective on 09-18-2025 until 09-18-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dietitian, Registered
- Taxonomy Code
- 133V00000X
- Type
- Dietary & Nutritional Service Providers
- License No.
- LD006597
- License State
- GA
- Taxonomy Description
- A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 09-18-2025
Opt-Out End Date: 09-18-2027
Eligible to Order and Refer? No
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1366122293, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1366122293, enumerated as an "individual" on July 25, 2023.
The provider is located at 1380 W MARIETTA ST NW ATLANTA, GA 30318 and the phone number is (614) 738-1343.
Dietitian, Registered with taxonomy code 133V00000X.
