Provider Demographics
NPI:1174192280
Name:WOODS, GLORIA LATRICE (PROVIDER)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LATRICE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7748
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7748
Mailing Address - Country:US
Mailing Address - Phone:843-591-5125
Mailing Address - Fax:
Practice Address - Street 1:1625 GREGG AVE APT B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3111
Practice Address - Country:US
Practice Address - Phone:843-591-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver