Provider Demographics
NPI:1235165689
Name:KRUEGER, JODI LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNN
Last Name:KRUEGER
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8274
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:2011 WINDSOR SPRING ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-798-1700
Practice Address - Fax:706-798-8626
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336988OtherWELLCARE
GA599460869AMedicaid
GA056123OtherLICENSE
GACH0654OtherRR MEDICARE GROUP PIN
GA10057033OtherAMERIGROUP
SCG56123Medicaid
SCG56123Medicaid