Provider Demographics
NPI:1134463250
Name:DOUTHIT, JODI M
Entity Type:Individual
Prefix:MISS
First Name:JODI
Middle Name:M
Last Name:DOUTHIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ASHBOURNE LAKE COURT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012
Mailing Address - Country:US
Mailing Address - Phone:336-757-2981
Mailing Address - Fax:
Practice Address - Street 1:240 ASHBOURNE LAKE CT
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-7905
Practice Address - Country:US
Practice Address - Phone:336-757-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC11344171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor