Healthcare Provider Details

I. General information

NPI: 1104818806
Provider Name (Legal Business Name): MICHELLE E MASON-WOODARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N WASHINGTON ST SUITE A
LINCOLNTON GA
30817-6037
US

IV. Provider business mailing address

PO BOX 1248
LINCOLNTON GA
30817-1248
US

V. Phone/Fax

Practice location:
  • Phone: 706-359-4215
  • Fax: 706-359-1662
Mailing address:
  • Phone: 706-359-4215
  • Fax: 706-359-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61981
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME137893
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52010
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.135090
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46168
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: