Healthcare Provider Details

I. General information

NPI: 1639094071
Provider Name (Legal Business Name): CAROLINE WOODRUM M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 DEARING EXT BLDG 2
ATHENS GA
30606-3579
US

IV. Provider business mailing address

115 PINE BARK LN
ATHENS GA
30605-7724
US

V. Phone/Fax

Practice location:
  • Phone: 706-357-5239
  • Fax:
Mailing address:
  • Phone: 706-881-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP009361
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: