Provider Demographics
NPI:1003314972
Name:WOODFORK, DORIS
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:WOODFORK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-1701
Mailing Address - Country:US
Mailing Address - Phone:240-210-4411
Mailing Address - Fax:601-487-6894
Practice Address - Street 1:11 CO LIN CIR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4452
Practice Address - Country:US
Practice Address - Phone:601-953-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator