Healthcare Provider Details

I. General information

NPI: 1114958741
Provider Name (Legal Business Name): RICHARD WOODCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE STREET, MOT GROUND FLOOR ,CRAWFORD LONG HOSPITAL
ATLANTA GA
30308
US

IV. Provider business mailing address

PO BOX 2326
INDIANAPOLIS IN
46206-2326
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-3952
  • Fax:
Mailing address:
  • Phone: 404-352-1409
  • Fax: 404-352-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number047380
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number47380
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: