Jodi M Douthit
Individual provider Active NPI Contractor · Clemmons, NC
NPI 1134463250 · NPPES record last updated Nov 15, 2012
Key facts
- NPI
- 1134463250
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- NC11344 (NC)
- Practice address
- 240 Ashbourne Lake CT
Clemmons, NC 27012-7905 - Phone
- (336) 757-2981
- NPI assigned
- Nov 15, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NC11344 | NC | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | NC11344 | NC | Yes |
Addresses
Primary practice location
240 Ashbourne Lake CT
Clemmons, NC 27012-7905
Mailing address
240 Ashbourne Lake Court
Clemmons, NC 27012
Phone (336) 757-2981
Other providers in Clemmons, NC
- Todd Michael Derreberry
- Rebecca Dey
- Rhonda Wallace Dixon
- Jeremy Dockery
- Terry Ann Donovan
- Dove Medical Supply Retail LLC
- Elisabeth Dowlen
- Brian William Downs
- Rose Kordich Doyle
- Stephanie Caudle Draker
All providers in Clemmons, NC · Contractor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.