Provider Demographics
NPI:1356095699
Name:WOODRUFF, CORRINE (RD, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15205 HIGHGROVE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3191
Mailing Address - Country:US
Mailing Address - Phone:303-916-6325
Mailing Address - Fax:
Practice Address - Street 1:15205 HIGHGROVE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-3191
Practice Address - Country:US
Practice Address - Phone:303-916-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA951152133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered