Healthcare Provider Details

I. General information

NPI: 1114140001
Provider Name (Legal Business Name): JODY D. IODICE PH.D., NCAC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LENOX POINTE NE STE B
ATLANTA GA
30324-3177
US

IV. Provider business mailing address

30 LENOX POINTE NE STEB STE B
ATLANTA GA
30324-3177
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-4646
  • Fax:
Mailing address:
  • Phone: 404-869-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberCERTIFICATION #0357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: