Provider Demographics
NPI:1700833829
Name:JIMMIE D. WOODLEE MD
Entity Type:Organization
Organization Name:JIMMIE D. WOODLEE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WOODLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-473-4214
Mailing Address - Street 1:155 HEALTH WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2658
Mailing Address - Country:US
Mailing Address - Phone:931-473-4214
Mailing Address - Fax:931-473-0666
Practice Address - Street 1:155 HEALTH WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2658
Practice Address - Country:US
Practice Address - Phone:931-473-4214
Practice Address - Fax:931-473-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719062Medicaid
TN3719062Medicare PIN