Provider Demographics
NPI:1578753182
Name:WODA, DEBRA L (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:WODA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:HARROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:2 MEDICAL PARK RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6839
Practice Address - Country:US
Practice Address - Phone:803-545-5700
Practice Address - Fax:803-434-4699
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3064367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0180Medicaid
SCP35726Medicare UPIN
SCQ503983922Medicare PIN
SCMW0180Medicaid