Provider Demographics
NPI:1417407404
Name:JAMES R WOODSON III DMD
Entity Type:Organization
Organization Name:JAMES R WOODSON III DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-988-6200
Mailing Address - Street 1:11 NORTHTOWN DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3699
Mailing Address - Country:US
Mailing Address - Phone:601-988-6200
Mailing Address - Fax:601-988-6203
Practice Address - Street 1:11 NORTHTOWN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3699
Practice Address - Country:US
Practice Address - Phone:601-988-6200
Practice Address - Fax:601-988-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3200-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty