Healthcare Provider Details

I. General information

NPI: 1972207496
Provider Name (Legal Business Name): COLEMAN WOODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB NC
27531
US

IV. Provider business mailing address

2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB NC
27531
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-1802
  • Fax:
Mailing address:
  • Phone: 919-722-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84688-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: