Provider Demographics
NPI:1942194048
Name:WALDRON, JODY C
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:C
Last Name:WALDRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:LYNX
Mailing Address - State:OH
Mailing Address - Zip Code:45650-9733
Mailing Address - Country:US
Mailing Address - Phone:937-892-0051
Mailing Address - Fax:
Practice Address - Street 1:154 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:LYNX
Practice Address - State:OH
Practice Address - Zip Code:45650-9733
Practice Address - Country:US
Practice Address - Phone:937-892-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor