Individual
JODY L AMAZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2160 FOUNTAIN DR STE 220, SNELLVILLE, GA 30078-7022
(678) 336-9102
(770) 674-8563
Mailing address
2160 FOUNTAIN DR STE 220, SNELLVILLE, GA 30078-7022
(678) 336-9102
(770) 674-8563
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R096082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000771196C
—
GA
01
—
50BBKVV
MEDICARE PROVIDER NUMBER
GA
Enumeration date
01/18/2006
Last updated
01/14/2021
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