MEDICARE: NADINE JODESTY

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1033584974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE JODESTY

Provider Business Mailing Address
First Line	:	260 SPRINGS XING
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8852
Country	:	US
Telephone Number	:	770-885-2907
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 SPRINGS XING
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8852
Country	:	US
Telephone Number	:	770-885-2907
Fax Number	:

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

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/03/2015

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Directions to “ NADINE JODESTY ” Practice Location

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