Provider Demographics
NPI:1639100308
Name:WOODY, EDITH (MD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:WOODY
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 1:3106 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-5109
Mailing Address - Country:US
Mailing Address - Phone:478-314-0890
Mailing Address - Fax:478-314-0894
Practice Address - Street 1:3106 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-5109
Practice Address - Country:US
Practice Address - Phone:478-314-0890
Practice Address - Fax:478-314-0894
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28673207P00000X
GA028673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA564758011AMedicaid
GA008829OtherBLUE CROSS
GA008829OtherBLUE CROSS
GA564758011AMedicaid