Provider Demographics
NPI:1407366107
Name:WOODARD, LYNEI CHERIE
Entity Type:Individual
Prefix:
First Name:LYNEI
Middle Name:CHERIE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 VETERANS MEMORIAL HWY SE STE 720
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7794
Mailing Address - Country:US
Mailing Address - Phone:707-320-7207
Mailing Address - Fax:
Practice Address - Street 1:1025 VETERANS MEMORIAL HWY SE STE 720
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7794
Practice Address - Country:US
Practice Address - Phone:770-732-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily