Healthcare Provider Details

I. General information

NPI: 1174528558
Provider Name (Legal Business Name): ALFRED HERMAN WOODWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 SHIPYARD BLVD
WILMINGTON NC
28403-6161
US

IV. Provider business mailing address

4402 SHIPYARD BLVD
WILMINGTON NC
28403-6161
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-1400
  • Fax: 910-332-1072
Mailing address:
  • Phone: 910-452-1400
  • Fax: 910-332-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17535
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17535
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: