Provider Demographics
NPI:1700923257
Name:HORTMAN, JODY (DC)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:HORTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 ROSWELL RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3173
Mailing Address - Country:US
Mailing Address - Phone:404-531-0055
Mailing Address - Fax:404-531-0369
Practice Address - Street 1:6600 ROSWELL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-531-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1003626OtherAETNA HMO
GA5796537OtherAETNA PPO
GA1003626OtherAETNA HMO