Healthcare Provider Details

I. General information

NPI: 1861828923
Provider Name (Legal Business Name): BETHANY WOODRUFF GRUBER RN, BSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY W ATKINS RN, BSN, NP-C

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SW PARK AVE
BAXLEY GA
31513-0703
US

IV. Provider business mailing address

73 SW PARK AVE STE B
BAXLEY GA
31513-2008
US

V. Phone/Fax

Practice location:
  • Phone: 912-705-8050
  • Fax: 912-705-8051
Mailing address:
  • Phone: 912-705-8051
  • Fax: 912-705-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN204317
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: