Provider Demographics
NPI:1841652922
Name:WOODS GREEN, JAMIE DENISE (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DENISE
Last Name:WOODS GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DENISE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1277 WELLBROOK CIR NE STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3973
Mailing Address - Country:US
Mailing Address - Phone:770-922-5745
Mailing Address - Fax:678-750-1406
Practice Address - Street 1:1277 WELLBROOK CIR NE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3973
Practice Address - Country:US
Practice Address - Phone:770-922-5745
Practice Address - Fax:678-750-1406
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA083197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003180139BMedicaid