Provider Demographics
NPI:1871655043
Name:WOODS, ENIS QUARDELL (DPT)
Entity Type:Individual
Prefix:
First Name:ENIS
Middle Name:QUARDELL
Last Name:WOODS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10955 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8109
Mailing Address - Country:US
Mailing Address - Phone:770-817-0197
Mailing Address - Fax:770-817-0204
Practice Address - Street 1:10955 JONES BRIDGE RD
Practice Address - Street 2:SUITE 131
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8109
Practice Address - Country:US
Practice Address - Phone:770-817-0197
Practice Address - Fax:770-817-0204
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2279844OtherFIRST HEALTH
GA9329177OtherPHCS
GA9329177OtherPHCS