Provider Demographics
NPI:1285650085
Name:WOODCOCK, JAMES D (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:WOODCOCK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 FOREST DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-3104
Mailing Address - Country:US
Mailing Address - Phone:803-782-4278
Mailing Address - Fax:803-782-3445
Practice Address - Street 1:1600 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6015
Practice Address - Country:US
Practice Address - Phone:843-238-1461
Practice Address - Fax:843-828-0622
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93704363L00000X
SC1977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04963Medicare UPIN
AA0253Medicare ID - Type Unspecified