Provider Demographics
NPI:1841305380
Name:STUTTS, JODI N (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:N
Last Name:STUTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:N
Other - Last Name:CUCINIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 896199
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6199
Mailing Address - Country:US
Mailing Address - Phone:833-936-1364
Mailing Address - Fax:605-942-7505
Practice Address - Street 1:544 BRAWLEY SCHOOL RD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9393
Practice Address - Country:US
Practice Address - Phone:704-360-5190
Practice Address - Fax:704-360-5180
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905323Medicaid
NC1841305380Medicaid
NC2057752Medicare PIN
NCI63130Medicare UPIN
NC2057752BMedicare PIN
NCNCK536AMedicare PIN
NC2057752AMedicare PIN