Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | PRV-111-15 | MS |
NPI | 1386758829 |
---|---|
Provider Name | Dr. Tina Rushing Woods |
First Address | Jackson, MS 39216-4505 |
Second Address | Jackson, MS 39216-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00660205 | (05) | MS |