Healthcare Provider Details

I. General information

NPI: 1679464523
Provider Name (Legal Business Name): DEMETRIA WOODRUFF PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JOHNSON FERRY RD STE 450
MARIETTA GA
30068-5433
US

IV. Provider business mailing address

1121 JOHNSON FERRY ROAD SUITE 450
MARIETTA GA
30068
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP003770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: