Healthcare Provider Details

I. General information

NPI: 1174387161
Provider Name (Legal Business Name): CLAIRE BROOKS WOODWARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COLISEUM PL
MACON GA
31217-3867
US

IV. Provider business mailing address

231 PIERCE AVE
MACON GA
31204-2419
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-7935
  • Fax:
Mailing address:
  • Phone: 478-960-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN295633
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN295633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: