MEDICARE: DR. GEORGE R WOODBURY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD-18701	TN

General Provider Information

NPI Number	:	1558367763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE R WOODBURY

Provider Business Mailing Address
First Line	:	8143 WALNUT GROVE RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7270
Country	:	US
Telephone Number	:	901-753-0168
Fax Number	:	901-754-4946

Provider Business Practice Location Address
First Line	:	8143 WALNUT GROVE RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7270
Country	:	US
Telephone Number	:	901-753-0168
Fax Number	:	901-754-4946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/24/2009

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