Basic Information
| Provider Information | |||||||||
| NPI: | 1437464427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLONS | ||||||||
| FirstName: | JODIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1180 ERNEST W BARRETT PKWY NW STE 102B | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301444534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783542273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35 JESSE HILL JR DR SE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047859500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2010 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN118621 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.