Healthcare Provider Details

I. General information

NPI: 1518969799
Provider Name (Legal Business Name): JODI E GANZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 PEACHTREE RD NE STE 500
ATLANTA GA
30326-1031
US

IV. Provider business mailing address

3379 PEACHTREE RD NE STE 500
ATLANTA GA
30326-1031
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-5484
  • Fax:
Mailing address:
  • Phone: 404-355-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101237581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: