MEDICARE: KEVIN JOSEPH WOODY

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	183500000X	Pharmacist	RPH018454	GA

General Provider Information

NPI Number	:	1992394142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN JOSEPH WOODY

Provider Business Mailing Address
First Line	:	PO BOX 439
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-0439
Country	:	US
Telephone Number	:	770-983-3510
Fax Number	:	770-983-7986

Provider Business Practice Location Address
First Line	:	5226 DAHLONEGA HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-1946
Country	:	US
Telephone Number	:	770-983-3510
Fax Number	:	770-983-7986

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ KEVIN JOSEPH WOODY ” Practice Location

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