Provider Demographics
NPI:1225209901
Name:WOOLEY, ANGELA C (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:C
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4068
Mailing Address - Country:US
Mailing Address - Phone:912-644-4900
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4068
Practice Address - Country:US
Practice Address - Phone:912-644-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA553125979AMedicaid
GARN115523OtherGEORGIA NP LICENSE
GA01182119OtherAMERIGROUP
GA553125979AMedicaid