Healthcare Provider Details

I. General information

NPI: 1548768427
Provider Name (Legal Business Name): CALVIN WOODFORK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CO LIN CIR
NATCHEZ MS
39120-4452
US

IV. Provider business mailing address

8 JANICE CIR
NATCHEZ MS
39120-4340
US

V. Phone/Fax

Practice location:
  • Phone: 601-953-9993
  • Fax: 601-487-6894
Mailing address:
  • Phone: 301-653-5054
  • Fax: 601-487-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: