Provider Demographics
NPI:1164543898
Name:WOODARD, TERRY WAYNE JR (HOME HEALTH PROVIDER)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:WAYNE
Last Name:WOODARD
Suffix:JR
Gender:M
Credentials:HOME HEALTH PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 TIMBER MILL CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-8573
Mailing Address - Country:US
Mailing Address - Phone:770-769-7832
Mailing Address - Fax:
Practice Address - Street 1:316 TIMBER MILL CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-8573
Practice Address - Country:US
Practice Address - Phone:770-769-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker