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Individual

DR. JACQUELYNE R BODEA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-BC, CNM

Contact information

Practice address
100 STONEFOREST DR STE 230, WOODSTOCK, GA 30189-4903
(470) 552-8470
Mailing address
10025 INVESTMENT DR STE 100, KNOXVILLE, TN 37932-2665
(865) 606-6110
(865) 312-6442

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN102394
GA
367A00000X
Advanced Practice Midwife
RN102394
GA

Other

Enumeration date
11/15/2006
Last updated
01/29/2022
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