Provider Demographics
NPI:1639560659
Name:WOOTEN, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WOOTEN
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30560-0427
Mailing Address - Country:US
Mailing Address - Phone:706-374-2020
Mailing Address - Fax:706-374-1199
Practice Address - Street 1:106 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:GA
Practice Address - Zip Code:30560-3716
Practice Address - Country:US
Practice Address - Phone:706-374-2020
Practice Address - Fax:706-374-1199
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001800156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician