Provider Demographics
NPI:1760450316
Name:WOOLEY, JOHN G II (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:WOOLEY
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:WOOLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1320 MADISON AVE S
Mailing Address - Street 2:#145
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 MADISON AVE S
Practice Address - Street 2:#145
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-4417
Practice Address - Country:US
Practice Address - Phone:850-251-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195551367500000X
FLARNP3283962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307649100Medicaid
FLG3981OtherBCBS OF FL
FLG3981OtherBCBS OF FL
FL307649100Medicaid