Provider Demographics
NPI:1407449960
Name:WOODS, AARON BLAINE
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BLAINE
Last Name:WOODS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHARING PL
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9172
Mailing Address - Country:US
Mailing Address - Phone:214-578-4943
Mailing Address - Fax:
Practice Address - Street 1:1057 LIBERTY PKWY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6449
Practice Address - Country:US
Practice Address - Phone:214-578-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14490363A00000X
TN5173363A00000X
NC0010-12385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant