Provider Demographics
NPI:1124851639
Name:WOODS, REBECCA SUE (FNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:WOODS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1710 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 BATTLEFIELD PKWY STE 200
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5168
Practice Address - Country:US
Practice Address - Phone:706-861-4990
Practice Address - Fax:706-841-0094
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36662363LF0000X
GAGAA-NP002544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily