Healthcare Provider Details

I. General information

NPI: 1255945572
Provider Name (Legal Business Name): KERRI WOODWARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OLD ALABAMA RD STE 119-251
JOHNS CREEK GA
30022-5860
US

IV. Provider business mailing address

3000 OLD ALABAMA RD STE 119-251
JOHNS CREEK GA
30022-5860
US

V. Phone/Fax

Practice location:
  • Phone: 770-810-5502
  • Fax:
Mailing address:
  • Phone: 770-810-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: