Provider Demographics
NPI:1417995440
Name:HANNAH, JODY LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LEIGH
Last Name:HANNAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-3438
Mailing Address - Fax:912-350-9037
Practice Address - Street 1:4700 WATERS AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-3438
Practice Address - Fax:912-350-9037
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA127369667BMedicaid
GAP00456206OtherRAILROAD MEDICARE
SC0713PAMedicaid
GA127369667DMedicaid
GA127369667EMedicaid
GA127369667HMedicaid
GA127369667CMedicaid
GA127369667AMedicaid
GA127369667FMedicaid
GA127369667GMedicaid
SC0713PAMedicaid
GA127369667GMedicaid