MEDICARE: MARISSA F WOODARD AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN-NP269097	GA

General Provider Information

NPI Number	:	1568148500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA F WOODARD AGNP-C

Provider Business Mailing Address
First Line	:	135 BOULEVARD ST N
Second Line	:
City	:	SMITHVILLE
State	:	GA
Zip	:	31787-2645
Country	:	US
Telephone Number	:	229-942-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 BOULEVARD ST N
Second Line	:
City	:	SMITHVILLE
State	:	GA
Zip	:	31787-2645
Country	:	US
Telephone Number	:	229-942-2288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	10/08/2025

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