Provider Demographics
NPI:1396748786
Name:WOODS, CHARLES D JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:WOODS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4348
Mailing Address - Country:US
Mailing Address - Phone:256-355-3645
Mailing Address - Fax:256-355-0610
Practice Address - Street 1:1320 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4348
Practice Address - Country:US
Practice Address - Phone:256-355-3645
Practice Address - Fax:256-355-0610
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-10-17
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AL00023250207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009965315Medicaid
AL009965315Medicaid
F18362Medicare UPIN