Healthcare Provider Details

I. General information

NPI: 1558547943
Provider Name (Legal Business Name): RODERIC L. WOODSON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 1040
ATLANTA GA
30309-1730
US

IV. Provider business mailing address

105 COLLIER RD NW STE 1040
ATLANTA GA
30309-1730
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-8522
  • Fax: 404-352-8300
Mailing address:
  • Phone: 404-352-8522
  • Fax: 404-352-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number060340
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number060340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: