Provider Demographics
NPI:1376917062
Name:DR. RODERIC L. WOODSON II M.D.
Entity Type:Organization
Organization Name:DR. RODERIC L. WOODSON II M.D.
Other - Org Name:GEORGIA RENAL SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RODERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-352-8522
Mailing Address - Street 1:105 COLLIER RD NW STE 1000
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1730
Mailing Address - Country:US
Mailing Address - Phone:404-352-8522
Mailing Address - Fax:
Practice Address - Street 1:105 COLLIER RD NW STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1730
Practice Address - Country:US
Practice Address - Phone:404-352-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty