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General NPI Number Information
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NPI Number | 1063454775
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Entity Type | Organization
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Legal Business Name | W M WOODWARD, MD, PA
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1124 SAM RITTENBERG BLVD SUITE 1
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City | CHARLESTON
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State | SC
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Zip | 29407-3362
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Country | US
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Telephone | 843-556-3462
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Fax | 843-766-2103
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Provider Business Mailing Address
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Address Line | 1124 SAM RITTENBERG BLVD SUITE 1
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City | CHARLESTON
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State | SC
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Zip | 29407-3362
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Country | US
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Telephone | 843-556-3462
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Fax | 843-766-2103
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY WAYNE BUNCHER SR.
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Credential | M.D.
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Telephone | 843-556-3462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15523
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License Number State | SC
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