MEDICARE: MISS JODI M DOUTHIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	NC11344	NC

General Provider Information

NPI Number	:	1134463250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JODI M DOUTHIT

Provider Business Mailing Address
First Line	:	240 ASHBOURNE LAKE COURT
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012
Country	:	US
Telephone Number	:	336-757-2981
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 ASHBOURNE LAKE CT
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-7905
Country	:	US
Telephone Number	:	336-757-2981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ MISS JODI M DOUTHIT ” Practice Location

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