Healthcare Provider Details

I. General information

NPI: 1164450730
Provider Name (Legal Business Name): JAMES S. WOODARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40023 CROSS CREEK DR
HAMILTON MS
39746-8801
US

IV. Provider business mailing address

410 GILMORE DR
AMORY MS
38821-5414
US

V. Phone/Fax

Practice location:
  • Phone: 662-343-5299
  • Fax: 662-343-8456
Mailing address:
  • Phone: 662-256-7114
  • Fax: 662-256-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11286
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: