Healthcare Provider Details

I. General information

NPI: 1619188505
Provider Name (Legal Business Name): WOODLEY BERNADETTE MARDY-DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12389 CRABAPPLE RD
ALPHARETTA GA
30004-6328
US

IV. Provider business mailing address

12389 CRABAPPLE RD
ALPHARETTA GA
30004-6328
US

V. Phone/Fax

Practice location:
  • Phone: 470-299-1998
  • Fax:
Mailing address:
  • Phone: 470-299-1998
  • Fax: 470-299-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number59463
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number59463
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number059463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: