Healthcare Provider Details

I. General information

NPI: 1215989967
Provider Name (Legal Business Name): GEORGE RAYMOND WOODRUFF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N HIGHWAY 81
ANDERSON SC
29621-3620
US

IV. Provider business mailing address

3030 N HIGHWAY 81
ANDERSON SC
29621-3620
US

V. Phone/Fax

Practice location:
  • Phone: 864-222-0019
  • Fax:
Mailing address:
  • Phone: 864-222-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number792
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number792
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number792
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number792
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number792
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: