1932108602 NPI number — MRS. FLORA J. WOOLFOLK

Table of content: MRS. FLORA J. WOOLFOLK (NPI 1932108602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932108602 NPI number — MRS. FLORA J. WOOLFOLK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLFOLK
Provider First Name:
FLORA
Provider Middle Name:
J.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
FLORA
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932108602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17203 JAMES MADISON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GORDONSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22942-8519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-832-0303
Provider Business Mailing Address Fax Number:
540-832-0303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17203 JAMES MADISON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GORDONSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22942-8519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-832-0303
Provider Business Practice Location Address Fax Number:
540-832-0303
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305001627 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010065925 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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