Provider Demographics
NPI:1427275353
Name:WOODS, JESSY G (MD)
Entity type:Individual
Prefix:
First Name:JESSY
Middle Name:G
Last Name:WOODS
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 1:1436 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1648
Mailing Address - Country:US
Mailing Address - Phone:122-327-4478
Mailing Address - Fax:812-232-6962
Practice Address - Street 1:1436 LOCUST ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1648
Practice Address - Country:US
Practice Address - Phone:812-232-7447
Practice Address - Fax:812-232-6962
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062542A207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN153868OtherRURAL HEALTH MEDICARE
IN200868190Medicaid
IN153868OtherRURAL HEALTH MEDICARE
IN153868Medicare Oscar/Certification