Provider Demographics
NPI:1144985722
Name:WOODARD, ASHLEY (RMA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MEADOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-4400
Mailing Address - Country:US
Mailing Address - Phone:601-551-0201
Mailing Address - Fax:601-600-2643
Practice Address - Street 1:223 3RD ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4101
Practice Address - Country:US
Practice Address - Phone:601-551-1697
Practice Address - Fax:601-600-2643
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS832235247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty