Provider Demographics
NPI:1396219382
Name:WOODS, MARK A (OWNER)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WOODS
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COMET DR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4333
Mailing Address - Country:US
Mailing Address - Phone:601-473-6228
Mailing Address - Fax:769-235-6832
Practice Address - Street 1:360 COMET DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4333
Practice Address - Country:US
Practice Address - Phone:601-473-6228
Practice Address - Fax:769-235-6832
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker