Provider Demographics
NPI:1114097938
Name:WOODBURY, GEORGE R SR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:WOODBURY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1716
Mailing Address - Country:US
Mailing Address - Phone:901-682-5606
Mailing Address - Fax:901-682-7853
Practice Address - Street 1:1200 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2440
Practice Address - Country:US
Practice Address - Phone:870-425-0672
Practice Address - Fax:870-425-0796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD3499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist