Provider Demographics
NPI:1598860272
Name:WOODMAN, GEORGE ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ELLIS
Last Name:WOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-869-2000
Mailing Address - Fax:901-869-2009
Practice Address - Street 1:6029 WALNUT GROVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-869-2000
Practice Address - Fax:901-869-2009
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000030177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69055Medicare UPIN