Healthcare Provider Details

I. General information

NPI: 1063946721
Provider Name (Legal Business Name): SAVANNAH LEE WOODWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 07/22/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I MARINE EXPEDITIONARY FORCE NMRTC CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

I MARINE EXPEDITIONARY FORCE NMRTC CAMP PENDLETON BOX 555191, ATTN: I MEF CREDENTIALING (RM 4172)
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-5100
  • Fax:
Mailing address:
  • Phone: 760-719-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD046459
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: