Basic Information
| Provider Information | |||||||||
| NPI: | 1629026851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | HUGH | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1824 WALTON WAY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309043804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067379250 | ||||||||
| FaxNumber: | 7067330697 | ||||||||
| Practice Location | |||||||||
| Address1: | 3651 WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309096521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067379250 | ||||||||
| FaxNumber: | 7067330697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN139429 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 431011979B | 05 | GA | MEDICAID |