Healthcare Provider Details

I. General information

NPI: 1245692342
Provider Name (Legal Business Name): MARTIA WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

IV. Provider business mailing address

3018 OLD MINDEN RD STE 1117
BOSSIER CITY LA
71112-2497
US

V. Phone/Fax

Practice location:
  • Phone: 318-459-6795
  • Fax:
Mailing address:
  • Phone: 318-777-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: