MEDICARE: VICTORIA H WOODS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN042095	GA

General Provider Information

NPI Number	:	1437128774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA H WOODS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 2070
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31515-2070
Country	:	US
Telephone Number	:	912-367-9841
Fax Number	:	912-367-9051

Provider Business Practice Location Address
First Line	:	163 E TOLLISON ST
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0120
Country	:	US
Telephone Number	:	912-367-9841
Fax Number	:	912-367-9051

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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