Provider Demographics
NPI:1063515013
Name:WOODS, EDDIE (DDS)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:WOODS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 RANDALL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3103
Mailing Address - Country:US
Mailing Address - Phone:678-358-6304
Mailing Address - Fax:770-441-0299
Practice Address - Street 1:100 CHASTAIN CENTER BLVD NW
Practice Address - Street 2:SUITE 135
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5559
Practice Address - Country:US
Practice Address - Phone:678-836-2115
Practice Address - Fax:770-441-0299
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist