Provider Demographics
NPI:1770110744
Name:HEMMINGS, JODIAN R (DO)
Entity type:Individual
Prefix:DR
First Name:JODIAN
Middle Name:R
Last Name:HEMMINGS
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 1:600 TRACY WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1262
Mailing Address - Country:US
Mailing Address - Phone:304-388-4965
Mailing Address - Fax:304-388-4200
Practice Address - Street 1:600 TRACY WAY STE 2
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1262
Practice Address - Country:US
Practice Address - Phone:304-388-4965
Practice Address - Fax:304-388-4200
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4495207QB0002X
FLOS0021069207QB0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program