Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 05726 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 076448 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 1509 | AL |
NPI | 1194080143 |
---|---|
Provider Name | Mrs. Jennifer Catherine Roberts-Woodbury |
First Address | Columbus, GA 31902-1038 |
Second Address | Columbus, GA 31901-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 20/09/2016 |