Individual
GARY E WOODHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1603 HIGHWAY 20 NE, SUITE 201, CONYERS, GA 30012-3736
(770) 929-8411
Mailing address
PO BOX 518, JONESBORO, GA 30237-0518
(770) 631-8277
(770) 631-9403
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
GA007821
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA007821
STATE LISC NUMBER
GA
Enumeration date
11/08/2006
Last updated
07/08/2007
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