Provider Demographics
NPI:1750038642
Name:WOODS, DWAINE
Entity type:Individual
Prefix:
First Name:DWAINE
Middle Name:
Last Name:WOODS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 OLD HAMMOND HWY STE B1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8288
Mailing Address - Country:US
Mailing Address - Phone:225-367-1646
Mailing Address - Fax:
Practice Address - Street 1:10319 OLD HAMMOND HWY STE B1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8288
Practice Address - Country:US
Practice Address - Phone:225-367-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1813541Medicaid