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General NPI Number Information
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NPI Number | 1073116661
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Entity Type | Individual
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Provider Name | STEVIE THOMAS WOODARD CEO/DIRECTOR
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Gender | Male
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 2585 KANLOW DR
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City | ANTIOCH
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State | TN
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Zip | 37013-3951
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Country | US
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Telephone | 615-635-3228
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Fax | 615-523-2104
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Provider Business Mailing Address
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Address Line | PO BOX 1008
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City | ANTIOCH
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State | TN
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Zip | 37011-1008
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Country | US
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Telephone | 615-635-3228
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Fax | 615-523-2104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 1000000027096
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License Number State | TN
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