Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CERTIFICATION #0357 | GA |
NPI | 1114140001 |
---|---|
Provider Name | Dr. Jody D. Iodice |
First Address | Atlanta, GA 30324-3177 |
Second Address | Atlanta, GA 30324-3177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |