Provider Demographics
NPI:1609431592
Name:WOODY, BOBBIE GREGORIA
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:GREGORIA
Last Name:WOODY
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 1:398 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5549
Mailing Address - Country:US
Mailing Address - Phone:614-224-2988
Mailing Address - Fax:614-716-0902
Practice Address - Street 1:1280 NORTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3181
Practice Address - Country:US
Practice Address - Phone:614-484-0789
Practice Address - Fax:614-824-2272
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator