Deborah Ann Woodward
Individual provider Active NPI Contractor · Lake Park, GA
NPI 1831671767 · NPPES record last updated Sep 6, 2018
Key facts
- NPI
- 1831671767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 612 Eagle Crest Dr
Lake Park, GA 31636-2751 - Phone
- (229) 506-2363
- NPI assigned
- Sep 6, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
612 Eagle Crest Dr
Lake Park, GA 31636-2751
Mailing address
612 Eagle Crest Dr
Lake Park, GA 31636-2751
Phone (229) 506-2363
Other providers in Lake Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.