MEDICARE: WAYNE M WOODBURY MD

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	208100000X	Physical Medicine & Rehabilitation Physician	042978	GA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	8397828-1205	UT
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	24642	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	552387	OTHER	GA	WELLCARE MEDICAID & MEDICARE
8	P00795760	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	01352928	OTHER	AMERIGROUP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770572893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE M WOODBURY MD

Provider Business Mailing Address
First Line	:	435 CHEROKEE MOUNTAIN RD
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-6637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 CHEROKEE MOUNTAIN RD
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-6637
Country	:	US
Telephone Number	:	912-596-2341
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	10/02/2025

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Directions to “ WAYNE M WOODBURY MD” Practice Location

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