Provider Demographics
NPI:1881749539
Name:WOODARD, G. MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:MARTIN
Last Name:WOODARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 BREEZEWOOD AVE
Mailing Address - Street 2:SUITE A - 5
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5504
Mailing Address - Country:US
Mailing Address - Phone:910-703-8551
Mailing Address - Fax:910-703-8556
Practice Address - Street 1:2711 BREEZEWOOD AVE
Practice Address - Street 2:SUITE A - 5
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5504
Practice Address - Country:US
Practice Address - Phone:910-703-8551
Practice Address - Fax:910-703-8551
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012695103G00000X, 103TA0400X, 103TA0700X, 103TC0700X, 103TC2200X, 103TF0200X
NC3635103G00000X, 103TA0400X, 103TA0700X, 103TC0700X, 103TF0200X, 106H00000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis