Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | RN238883 | GA |
Y | 363L00000X | Nurse Practitioner | RN238883 | GA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN238883 | GA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN238883 | GA |
NPI | 1164040036 |
---|---|
Provider Name | Kenneth Keith Woodington |
First Address | Decatur, GA 30033-4723 |
Second Address | Decatur, GA 30033-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN238883 | RN / APRN (01) | GA |