Healthcare Provider Details

I. General information

NPI: 1669714861
Provider Name (Legal Business Name): BETHANY JOY LOCKWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY JOY BRISBIN M.D.

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2957
  • Fax: 614-688-3700
Mailing address:
  • Phone: 614-293-2957
  • Fax: 614-688-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.126106
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.126106
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.126106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: