Provider Demographics
NPI:1871632125
Name:HIGDON, JENNIFER ANN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HIGDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-320-8687
Mailing Address - Fax:706-320-8609
Practice Address - Street 1:1800 10TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1513
Practice Address - Country:US
Practice Address - Phone:706-320-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831091DMedicaid
GA08CBBFHMedicare PIN
H06461Medicare UPIN