Healthcare Provider Details

I. General information

NPI: 1851038186
Provider Name (Legal Business Name): CHRISTOPHER PHILLIP WOODY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 HIGHWAY 34 E
SHARPSBURG GA
30277-3531
US

IV. Provider business mailing address

90 BEAVER CREEK LN
SHARPSBURG GA
30277-2244
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-1282
  • Fax:
Mailing address:
  • Phone: 678-877-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT000739
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: