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General NPI Number Information
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NPI Number | 1699545822
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Entity Type | Individual
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Provider Name | JODY MILFORD BAHAM FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 138 CANAL ST STE 201
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City | POOLER
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State | GA
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Zip | 31322-4047
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Country | US
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Telephone | 912-348-3383
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Fax | 912-348-2669
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Provider Business Mailing Address
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Address Line | 413 GRAVEL WAY
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City | BLOOMINGDALE
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State | GA
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Zip | 31302-8120
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Country | US
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Telephone | 706-599-7174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN287159
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | RN287159
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | RN287159
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | RN287159
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License Number State | GA
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