Provider Demographics
NPI:1700953965
Name:WOODWORTH FAMILY MEDICINE INC.
Entity Type:Organization
Organization Name:WOODWORTH FAMILY MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-484-9588
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-0406
Mailing Address - Country:US
Mailing Address - Phone:318-484-9588
Mailing Address - Fax:318-484-9590
Practice Address - Street 1:9372 HWY. 165 S.
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485
Practice Address - Country:US
Practice Address - Phone:318-484-9588
Practice Address - Fax:318-484-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty