=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508800087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT MATTHEW WOODBURN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 CURTIS ELLIS DR
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27804-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-451-3340
-----------------------------------------------------
Fax | 252-451-3320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 52007
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30355-0007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-397-0060
-----------------------------------------------------
Fax | 678-397-0065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------