Healthcare Provider Details

I. General information

NPI: 1295765022
Provider Name (Legal Business Name): THOMAS CASEY WOODRING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MATTHEW DR SUITE A
WAYNESBORO MS
39367-2553
US

IV. Provider business mailing address

920 MATTHEW DR SUITE A
WAYNESBORO MS
39367-2553
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18120
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: