Provider Demographics
NPI:1184689226
Name:ATWOOD, JEAN M (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:ATWOOD-NICKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3600 STELZER ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-475-0811
Mailing Address - Fax:614-475-0857
Practice Address - Street 1:3600 STELZER ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-475-0811
Practice Address - Fax:614-475-0857
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH160043334OtherRAILROAD MEDICARE
OH0825076Medicaid
OHN10745091Medicare PIN
OHAT0745094Medicare PIN
E86934Medicare UPIN