Provider Demographics
NPI:1720073778
Name:WOODS, GREGORY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:WOODS
Suffix:
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 1:1404 RIVER PL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5600
Mailing Address - Country:US
Mailing Address - Phone:770-848-6190
Mailing Address - Fax:770-848-5364
Practice Address - Street 1:1404 RIVER PL
Practice Address - Street 2:SUITE 401
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5600
Practice Address - Country:US
Practice Address - Phone:770-848-6190
Practice Address - Fax:770-848-5364
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72174207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936150Medicaid
IN000000610108OtherANTHEM
IN259370JMedicare PIN