Healthcare Provider Details

I. General information

NPI: 1104947993
Provider Name (Legal Business Name): LINDA A WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SQUIRREL TRAIL
REIDSVILLE NC
27320
US

IV. Provider business mailing address

476 NC HIGHWAY 87
REIDSVILLE NC
27320-9724
US

V. Phone/Fax

Practice location:
  • Phone: 336-349-2585
  • Fax: 336-349-3174
Mailing address:
  • Phone: 336-349-2585
  • Fax: 336-349-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberFCL079016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: