Healthcare Provider Details

I. General information

NPI: 1700833829
Provider Name (Legal Business Name): JIMMIE D. WOODLEE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HEALTH WAY SUITE 2
MC MINNVILLE TN
37110-2658
US

IV. Provider business mailing address

155 HEALTH WAY SUITE 2
MC MINNVILLE TN
37110-2658
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-4214
  • Fax: 931-473-0666
Mailing address:
  • Phone: 931-473-4214
  • Fax: 931-473-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIMMIE DALE WOODLEE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 931-473-4214