Basic Information
| Provider Information | |||||||||
| NPI: | 1154535433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEREZA-HARRIS | ||||||||
| FirstName: | GINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911400 | ||||||||
| FaxNumber: | 3046911453 | ||||||||
| Practice Location | |||||||||
| Address1: | COMMUNITY HEALTH SYSTEMS INC. | ||||||||
| Address2: | 410 CARRIAGE DR | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042551541 | ||||||||
| FaxNumber: | 3042537076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 23405 | WV | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.