Provider Demographics
NPI:1033584974
Name:JODESTY, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JODESTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SPRINGS XING
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8852
Mailing Address - Country:US
Mailing Address - Phone:770-885-2907
Mailing Address - Fax:
Practice Address - Street 1:260 SPRINGS XING
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8852
Practice Address - Country:US
Practice Address - Phone:770-885-2907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker