Provider Demographics
NPI:1669451845
Name:WOODLIFF, JILL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:WOODLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-1530
Mailing Address - Fax:601-984-1531
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6426
Practice Address - Fax:601-984-6439
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08581207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125027Medicaid
AL178238Medicaid
MS00125027Medicaid
AL178238Medicaid
MS333096YJ5DMedicare PIN
MS220000159Medicare PIN