Provider Demographics
NPI:1811922628
Name:WOODWARD, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WOODWARD
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 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070420A2084N0400X
KY516222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100581780Medicaid
ININ3977012Medicaid
NDDA9011028236OtherPREFERRED ONE #
NDND200216OtherLHS #
ND0500233OtherMEDICA #
ND1430502OtherAMERICA'S PPO/ARAZ #
ND44G74WOOtherMNBS #
ND11621Medicaid
ND0500191OtherMEDICA #
ND100515400Medicaid
ND20798OtherNDBS #
ND100515400Medicaid
NDND200216OtherLHS #
ND20798Medicare ID - Type UnspecifiedND MEDICARE #