MEDICARE: MR. GARY R. WOODS SR. MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0714	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	046KG	OTHER	NC	BC/BS

General Provider Information

NPI Number	:	1073694469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY R. WOODS SR. MA

Provider Business Mailing Address
First Line	:	321 7TH ST NE
Second Line	:	SUITE A
City	:	HICKORY
State	:	NC
Zip	:	28601
Country	:	US
Telephone Number	:	828-327-3172
Fax Number	:	828-324-2320

Provider Business Practice Location Address
First Line	:	321 7TH ST NE
Second Line	:	SUITE A
City	:	HICKORY
State	:	NC
Zip	:	28601-5113
Country	:	US
Telephone Number	:	828-327-3172
Fax Number	:	828-324-2320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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