Provider Demographics
NPI:1275710998
Name:MICHELLE MASON-WOODARD, MD
Entity Type:Organization
Organization Name:MICHELLE MASON-WOODARD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:706-359-2419
Mailing Address - Street 1:144 N PEACHTREE ST
Mailing Address - Street 2:P.O. BOX 295
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-0295
Mailing Address - Country:US
Mailing Address - Phone:706-359-2419
Mailing Address - Fax:706-359-2611
Practice Address - Street 1:144 N PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817-0295
Practice Address - Country:US
Practice Address - Phone:706-359-2419
Practice Address - Fax:706-359-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046168305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4333Medicare PIN