Provider Demographics
NPI:1548219983
Name:ANDREWS BODI, ANNIE KRISTEN (PA C)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:KRISTEN
Last Name:ANDREWS BODI
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:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042-0225
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:144 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:IRWINTON
Practice Address - State:GA
Practice Address - Zip Code:31042-0225
Practice Address - Country:US
Practice Address - Phone:478-864-3448
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004997OtherLICENSE
GA004997OtherLICENSE
GAQ48688Medicare UPIN