MEDICARE: JASON SCOT BRODY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036110895	IL
2	207W00000X	Ophthalmology Physician	063298	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1522	OTHER	SC	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427052497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SCOT BRODY M.D.

Provider Business Mailing Address
First Line	:	1065 JODECO RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-4953
Country	:	US
Telephone Number	:	678-284-6314
Fax Number	:	678-284-6282

Provider Business Practice Location Address
First Line	:	800 MOUNT VERNON HWY
Second Line	:	SUITE 125
City	:	ATLANTA
State	:	GA
Zip	:	30328-4295
Country	:	US
Telephone Number	:	404-256-1125
Fax Number	:	404-256-1964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	12/10/2009

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Directions to “ JASON SCOT BRODY M.D.” Practice Location

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