MEDICARE: JAMI S WOODHAM M.S,R.D.,L.D.

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	133V00000X	Registered Dietitian	D0162	MS

General Provider Information

NPI Number	:	1538146808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI S WOODHAM M.S,R.D.,L.D.

Provider Business Mailing Address
First Line	:	11 51ST ST
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-4431
Country	:	US
Telephone Number	:	228-547-5954
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VETERANS AVE
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-2410
Country	:	US
Telephone Number	:	228-523-5838
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	09/28/2012

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