Provider Demographics
NPI:1174550727
Name:WOODS, CARL ALLEN JR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:ALLEN
Last Name:WOODS
Suffix:JR
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 1:4235 VAL DEL RD
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2715
Mailing Address - Country:US
Mailing Address - Phone:229-560-0260
Mailing Address - Fax:
Practice Address - Street 1:4235 VAL DEL RD
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-2715
Practice Address - Country:US
Practice Address - Phone:229-560-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026688207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319536DMedicaid
D42093Medicare UPIN
GA00319536DMedicaid