Provider Demographics
NPI:1497161715
Name:CROCKETT-WOODS, HARRIET (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:
Last Name:CROCKETT-WOODS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HARRIET
Other - Middle Name:CHANTAY
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10545 WILLOW VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6551
Mailing Address - Country:US
Mailing Address - Phone:662-347-1930
Mailing Address - Fax:
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3950208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice