Healthcare Provider Details

I. General information

NPI: 1770893752
Provider Name (Legal Business Name): ANDREW D WOODS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WOODROW WILSON DR
VALDOSTA GA
31602-2628
US

IV. Provider business mailing address

501 W ONEIDA ST
WAYCROSS GA
31501-5337
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-7707
  • Fax: 229-245-8707
Mailing address:
  • Phone: 912-283-7596
  • Fax: 912-283-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001157
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: