Healthcare Provider Details

I. General information

NPI: 1538156674
Provider Name (Legal Business Name): MARK A WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 34TH ST
NORTHPORT AL
35473-3393
US

IV. Provider business mailing address

3544 GRAND ARBOR DR
TUSCALOOSA AL
35406-2926
US

V. Phone/Fax

Practice location:
  • Phone: 205-339-5900
  • Fax: 205-343-7425
Mailing address:
  • Phone: 205-454-1483
  • Fax: 205-343-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12835
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: