Provider Demographics
NPI:1750476016
Name:WOESSNER, DEREK A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:A
Last Name:WOESSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3072
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:2257 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7790
Practice Address - Country:US
Practice Address - Phone:334-245-6605
Practice Address - Fax:334-821-3191
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA051194207Q00000X
ALMD.28193207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine