Provider Demographics
NPI:1811050933
Name:CHITWOOD, JODI LYNN (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-350-1010
Mailing Address - Fax:404-355-7338
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-350-1010
Practice Address - Fax:404-355-7338
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA053118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA215105OtherBLUE CROSS BLUE SHIELD
GA5820010480000EOtherFED I.D.
GA582001048OtherTAX I.D.
GAI 09731Medicare UPIN
GAP00202536Medicare ID - Type UnspecifiedMEDICARE RAILROAD
GA5820010480000EOtherFED I.D.