Provider Demographics
NPI:1750960449
Name:WOODSON, JOHNNIE MAURICE III
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:MAURICE
Last Name:WOODSON
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO MSC10 5550
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6331
Mailing Address - Fax:505-272-0475
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO MSC10 5550
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2021-0402390200000X
NM390200000X
AZ76669208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program