Provider Demographics
NPI:1669423547
Name:WOODY, RONALD H (PAC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:WOODY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:HEALTH STAR PHYSICIANS STE 400B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-586-2410
Mailing Address - Fax:423-581-9692
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:HEALTH STAR PHYSICIANS STE 400B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-586-2410
Practice Address - Fax:423-581-9692
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3669317Medicaid
TN3669317Medicare PIN
TN3669317Medicaid