Basic Information
| Provider Information | |||||||||
| NPI: | 1811922701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | ARCH | ||||||||
| MiddleName: | NMN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27 | ||||||||
| Address2: | |||||||||
| City: | BAKERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287050027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286882104 | ||||||||
| FaxNumber: | 8286881334 | ||||||||
| Practice Location | |||||||||
| Address1: | 86 N MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287056502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286882104 | ||||||||
| FaxNumber: | 8286881334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 05/13/2010 | ||||||||
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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 | 207Q00000X | 22202 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8989081 | 05 | NC | MEDICAID |