Healthcare Provider Details

I. General information

NPI: 1780608869
Provider Name (Legal Business Name): PETER C WOODS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W.G. ACKER DRIVE
PICKENS SC
29671
US

IV. Provider business mailing address

123 W.G. ACKER DRIVE PO BOX 188
PICKENS SC
29671
US

V. Phone/Fax

Practice location:
  • Phone: 864-878-4791
  • Fax:
Mailing address:
  • Phone: 864-878-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: