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General NPI Number Information
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NPI Number | 1912770249
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Entity Type | Individual
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Provider Name | LADEIDRA NICOLE WOOTEN RN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 4250 ANTELOPE LN
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City | SNELLVILLE
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State | GA
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Zip | 30039-5694
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Country | US
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Telephone | 770-778-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 ANTELOPE LN
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City | SNELLVILLE
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State | GA
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Zip | 30039-5694
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Country | US
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Telephone | 770-778-1702
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Fax |
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | RN243005
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | RN243005
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | MT013436
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN243005
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | RN243005
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | RN243005
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | RN243005
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | RN243005
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License Number State | GA
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Taxonomy #9
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number | RN243005
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License Number State | GA
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