Provider Demographics
NPI:1689905895
Name:WOODLAWN FAMILY CARE INC
Entity Type:Organization
Organization Name:WOODLAWN FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSSY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-098-7654
Mailing Address - Street 1:3020 PROSPERITY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7197
Mailing Address - Country:US
Mailing Address - Phone:281-098-7654
Mailing Address - Fax:
Practice Address - Street 1:3020 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7197
Practice Address - Country:US
Practice Address - Phone:281-098-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty