Provider Demographics
NPI:1962096180
Name:WOODSON, DIONNE NICHOLE
Entity type:Individual
Prefix:MRS
First Name:DIONNE
Middle Name:NICHOLE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIONNE
Other - Middle Name:NICHOLE
Other - Last Name:CALLOWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 LAKESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-8845
Mailing Address - Country:US
Mailing Address - Phone:678-449-6488
Mailing Address - Fax:
Practice Address - Street 1:55 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-8845
Practice Address - Country:US
Practice Address - Phone:678-449-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist