Provider Demographics
NPI:1851893093
Name:WOODEN, JANAY LASHAUNDA (HAIR REPLACEMENT SPE)
Entity Type:Individual
Prefix:
First Name:JANAY
Middle Name:LASHAUNDA
Last Name:WOODEN
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5437 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3213
Practice Address - Country:US
Practice Address - Phone:678-515-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management