Provider Demographics
NPI:1871789271
Name:BAHNMILLER-BRASIL, JODY MARIE (MD)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:MARIE
Last Name:BAHNMILLER-BRASIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:BAHNMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:3575 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1027
Practice Address - Country:US
Practice Address - Phone:770-848-5300
Practice Address - Fax:770-848-5301
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069760207Q00000X, 207Q00000X
MS21209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine