Provider Demographics
NPI:1700070901
Name:WOODRUFF, ALICE EVELYN (FNP)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:EVELYN
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1722
Mailing Address - Country:US
Mailing Address - Phone:706-546-1333
Mailing Address - Fax:706-546-6807
Practice Address - Street 1:108 PARK AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1722
Practice Address - Country:US
Practice Address - Phone:706-546-1333
Practice Address - Fax:706-546-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123354 NP364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health