Healthcare Provider Details

I. General information

NPI: 1730255217
Provider Name (Legal Business Name): WOODSTOCK HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28921 HIGHWAY 5
WOODSTOCK AL
35188-3613
US

IV. Provider business mailing address

28921 HIGHWAY 5
WOODSTOCK AL
35188-3613
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-4655
  • Fax: 205-333-4660
Mailing address:
  • Phone: 205-333-4655
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF CAPLES
Title or Position: MANAGER
Credential:
Phone: 205-333-4655