Healthcare Provider Details

I. General information

NPI: 1952710857
Provider Name (Legal Business Name): DENISE WOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 POINTE CENTER DR STE 110
CHATTANOOGA TN
37421-4143
US

IV. Provider business mailing address

7119 ELMBROOK LN
HARRISON TN
37341-3938
US

V. Phone/Fax

Practice location:
  • Phone: 423-322-4483
  • Fax:
Mailing address:
  • Phone: 423-322-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN0000110140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: