Provider Demographics
NPI:1164180311
Name:WOODARD, HEIDI K (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:K
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CAPT MATTHEW FREEMAN DR
Mailing Address - Street 2:SUITE 159
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-756-2611
Mailing Address - Fax:912-756-4828
Practice Address - Street 1:66 CAPT MATTHEW FREEMAN DR
Practice Address - Street 2:SUITE 159
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-2611
Practice Address - Fax:912-756-4828
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2022-02-23
Deactivation Date:2022-02-04
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
GARN118133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse