Provider Demographics
NPI:1114140001
Name:IODICE, JODY D (PHD, NCAC-II)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:D
Last Name:IODICE
Suffix:
Gender:F
Credentials:PHD, NCAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LENOX POINTE NE STEB
Mailing Address - Street 2:STE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3177
Mailing Address - Country:US
Mailing Address - Phone:404-869-4646
Mailing Address - Fax:
Practice Address - Street 1:30 LENOX POINTE NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3177
Practice Address - Country:US
Practice Address - Phone:404-869-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACERTIFICATION #0357103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)