Provider Demographics
NPI:1154496693
Name:VANN, JODI W (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:W
Last Name:VANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2729
Mailing Address - Country:US
Mailing Address - Phone:404-814-9199
Mailing Address - Fax:404-869-8118
Practice Address - Street 1:4400 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-2729
Practice Address - Country:US
Practice Address - Phone:404-814-9199
Practice Address - Fax:404-869-8118
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0419882083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG39115Medicare UPIN