Healthcare Provider Details

I. General information

NPI: 1013851708
Provider Name (Legal Business Name): DEVAN TAYLOR WOODY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 HIGH ST APT 201
JOHNSON CITY TN
37604-3798
US

IV. Provider business mailing address

1113 HIGH ST APT 201
JOHNSON CITY TN
37604-3798
US

V. Phone/Fax

Practice location:
  • Phone: 828-284-7656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: