Provider Demographics
NPI:1710372305
Name:CODY, JESSICA REIN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:REIN
Last Name:CODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:REIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 GOLF HOUSE CT E
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9296
Mailing Address - Country:US
Mailing Address - Phone:336-449-9848
Mailing Address - Fax:
Practice Address - Street 1:940 GOLF HOUSE CT E
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9296
Practice Address - Country:US
Practice Address - Phone:336-449-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2019-02148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program