Provider Demographics
NPI:1396938213
Name:CHARLES D WOODS, MD PC
Entity type:Organization
Organization Name:CHARLES D WOODS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-355-3645
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529920690Medicaid
AL009965315Medicaid
F18362Medicare UPIN
AL009965315Medicaid
AL529920690Medicaid