Healthcare Provider Details

I. General information

NPI: 1003200577
Provider Name (Legal Business Name): SEAN DANIEL WOODS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2112
  • Fax:
Mailing address:
  • Phone: 404-778-1440
  • Fax: 404-778-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number63047
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: