Provider Demographics
NPI:1588265235
Name:WOODARD, JAMES NATHAN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NATHAN
Last Name:WOODARD
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PARKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2925
Mailing Address - Country:US
Mailing Address - Phone:205-514-1274
Mailing Address - Fax:
Practice Address - Street 1:3690 GRANDVIEW PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:205-971-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2022-03-21
Deactivation Date:2022-01-31
Deactivation Code:
Reactivation Date:2022-03-21
Provider Licenses
StateLicense IDTaxonomies
AL1-126221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse