Individual
JASON SCOT BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 MOUNT VERNON HWY, SUITE 125, ATLANTA, GA 30328-4295
(404) 256-1125
(404) 256-1964
Mailing address
1065 JODECO RD, STOCKBRIDGE, GA 30281-4953
(678) 284-6314
(678) 284-6282
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036110895
IL
207W00000X
Ophthalmology Physician
Primary
063298
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1522
MEDICARE ID
SC
05
—
PA1603
—
SC
Enumeration date
06/08/2005
Last updated
12/10/2009
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