Provider Demographics
NPI:1225240179
Name:HUGHES, JODY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:MICHAEL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1664 MULKEY RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:770-999-2599
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68034207RC0200X, 207RP1001X, 207RP1001X
AL27806207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09182254Medicaid
AL128696Medicaid
AL128697Medicaid
AL051116829OtherBCBS
AL051116830OtherBCBS
AL128691Medicaid
AL051116828OtherBCBS
MS09182254Medicaid