Provider Demographics
NPI:1386965598
Name:CASTLEBERRY, JESSICA HAINES (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HAINES
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W GORDON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3427
Mailing Address - Country:US
Mailing Address - Phone:706-647-9627
Mailing Address - Fax:
Practice Address - Street 1:917 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3427
Practice Address - Country:US
Practice Address - Phone:706-647-9627
Practice Address - Fax:706-647-9651
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology