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General NPI Number Information
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NPI Number | 1154796563
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Entity Type | Organization
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Legal Business Name | MICHELLE WOODARD M.D LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 2410 HOG MOUNTAIN RD STE 303
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4850
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Country | US
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Telephone | 706-705-6070
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Fax | 706-705-6075
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Provider Business Mailing Address
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Address Line | 2410 HOG MOUNTAIN RD STE 303
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4850
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Country | US
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Telephone | 706-705-6070
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Fax | 706-705-6075
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MISS MELISSA BARNEY
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Credential |
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Telephone | 706-705-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 061022
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License Number State | GA
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