Healthcare Provider Details

I. General information

NPI: 1366797656
Provider Name (Legal Business Name): JODY LOUISE KERSHNER MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 FOREST GREEN CT
MARIETTA GA
30062-2503
US

IV. Provider business mailing address

2288 FOREST GREEN CT
MARIETTA GA
30062-2503
US

V. Phone/Fax

Practice location:
  • Phone: 404-308-7057
  • Fax: 770-977-7057
Mailing address:
  • Phone: 404-308-7057
  • Fax: 770-977-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: