Provider Demographics
NPI:1942840574
Name:WOODWARD, BRADFORD SCOTT
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:SCOTT
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 HOLLY HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3781
Mailing Address - Country:US
Mailing Address - Phone:706-399-8865
Mailing Address - Fax:
Practice Address - Street 1:3104 HOLLY HAVEN DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3781
Practice Address - Country:US
Practice Address - Phone:706-399-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse