Provider Demographics
NPI:1164450730
Name:WOODARD, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:WOODARD
Suffix:
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 1:410 GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5414
Mailing Address - Country:US
Mailing Address - Phone:662-256-7114
Mailing Address - Fax:662-256-7116
Practice Address - Street 1:40023 CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-8801
Practice Address - Country:US
Practice Address - Phone:662-343-5299
Practice Address - Fax:662-343-8456
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116149Medicaid
AL730-74346OtherBC/BS OF ALABAMA
MS110127291OtherRAILROAD MEDICARE PROVIDE
MSB31087Medicare UPIN
MS110000759Medicare PIN
MS00116149Medicaid