Healthcare Provider Details

I. General information

NPI: 1861452849
Provider Name (Legal Business Name): JOHN B WOODS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE STE 500
MEMPHIS TN
38119-4808
US

IV. Provider business mailing address

1407 UNION AVE STE 700
MEMPHIS TN
38104-3641
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8630
  • Fax:
Mailing address:
  • Phone: 901-866-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21758
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number21758
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: