Basic Information
| Provider Information | |||||||||
| NPI: | 1306873815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODRUM | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | ORRIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 MITCHELL LN | ||||||||
| Address2: | |||||||||
| City: | STAUNTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244015593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408879690 | ||||||||
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| Practice Location | |||||||||
| Address1: | AUGUSTA MEDICAL CENTER ANESTHESIA DEPT | ||||||||
| Address2: | 78 MEDICAL CENTER DRIVE | ||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403324326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 046346 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 005762332 | 05 | VA | MEDICAID |