Provider Demographics
NPI:1619188505
Name:MARDY-DAVIS, WOODLEY BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:WOODLEY
Middle Name:BERNADETTE
Last Name:MARDY-DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12389 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6328
Mailing Address - Country:US
Mailing Address - Phone:470-299-1998
Mailing Address - Fax:470-299-1898
Practice Address - Street 1:12389 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6328
Practice Address - Country:US
Practice Address - Phone:470-299-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59463207L00000X, 207LA0401X
GA059463208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3951183OtherCIGNA
GA52207649OtherBLUE CROSS
GA600457898Medicaid
GA3951183OtherCIGNA
GA511I050225Medicare PIN