Basic Information
| Provider Information | |||||||||
| NPI: | 1407366107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | LYNEI | ||||||||
| MiddleName: | CHERIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 VETERANS MEMORIAL HWY SE STE 720 | ||||||||
| Address2: | |||||||||
| City: | MABLETON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301267794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073207207 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 VETERANS MEMORIAL HWY SE STE 720 | ||||||||
| Address2: | |||||||||
| City: | MABLETON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301267794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707320720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2017 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN218034 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.