MEDICARE: ELIZABETH RENAE WOOTEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144737818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RENAE WOOTEN

Provider Business Mailing Address
First Line	:	2727 PACES FERRY RD SE STE 750
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4053
Country	:	US
Telephone Number	:	850-240-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	16941 N EAGLE RIVER LOOP RD
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7824
Country	:	US
Telephone Number	:	907-726-5330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	02/09/2026

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