Healthcare Provider Details

I. General information

NPI: 1881749539
Provider Name (Legal Business Name): G. MARTIN WOODARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 BREEZEWOOD AVE SUITE A - 5
FAYETTEVILLE NC
28303-5504
US

IV. Provider business mailing address

2711 BREEZEWOOD AVE SUITE A - 5
FAYETTEVILLE NC
28303-5504
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-8551
  • Fax: 910-703-8551
Mailing address:
  • Phone: 910-703-8551
  • Fax: 910-703-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number012695
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number012695
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number012695
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012695
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number012695
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number012695
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3635
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number3635
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number3635
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3635
License Number StateNC
# 11
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3635
License Number StateNC
# 12
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3635
License Number StateNC
# 13
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number3635
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: