Provider Demographics
NPI:1821014788
Name:WOODSON-ALLEN, BECKY DIANE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:DIANE
Last Name:WOODSON-ALLEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 TEE DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-4023
Mailing Address - Country:US
Mailing Address - Phone:770-614-0512
Mailing Address - Fax:770-614-9190
Practice Address - Street 1:2230 TEE DR
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-4023
Practice Address - Country:US
Practice Address - Phone:770-614-0512
Practice Address - Fax:770-614-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00578751AMedicaid
GA43ZCBFQ29Medicare ID - Type Unspecified
GAR60347Medicare UPIN