Healthcare Provider Details

I. General information

NPI: 1770110744
Provider Name (Legal Business Name): JODIAN R HEMMINGS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

IV. Provider business mailing address

600 TRACY WAY STE 2
CHARLESTON WV
25311-1262
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4965
  • Fax: 304-388-4200
Mailing address:
  • Phone: 304-388-4965
  • Fax: 304-388-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number4495
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberOS0021069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: