Healthcare Provider Details

I. General information

NPI: 1073663811
Provider Name (Legal Business Name): KATRINA CALHOUN WOODARD CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA ANNE CALHOUN

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARTHA BERRY BLVD NW
ROME GA
30165
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-1470
  • Fax: 706-238-8081
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN082783
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: