Provider Demographics
NPI:1881652550
Name:WOODHAMS, J TREVOR (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:TREVOR
Last Name:WOODHAMS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1140 HAMMOND DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5554
Mailing Address - Country:US
Mailing Address - Phone:770-394-4000
Mailing Address - Fax:770-913-0841
Practice Address - Street 1:1140 HAMMOND DR NE
Practice Address - Street 2:E5100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-394-4000
Practice Address - Fax:770-913-0841
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA020627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD31437Medicare UPIN