Healthcare Provider Details

I. General information

NPI: 1083742654
Provider Name (Legal Business Name): STACEY LYNN WOODSON HS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 W IRIS DR
NASHVILLE TN
37204
US

IV. Provider business mailing address

2333 WILLESDEN GREEN CT.
HERMITAGE TN
37076
US

V. Phone/Fax

Practice location:
  • Phone: 615-269-5170
  • Fax: 615-269-8015
Mailing address:
  • Phone: 615-889-1418
  • Fax: 615-884-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: