Provider Demographics
NPI:1104818806
Name:MASON-WOODARD, MICHELLE E (MD, PC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:MASON-WOODARD
Suffix:
Gender:F
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-1248
Mailing Address - Country:US
Mailing Address - Phone:706-359-4215
Mailing Address - Fax:706-359-1662
Practice Address - Street 1:611 N WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817-6037
Practice Address - Country:US
Practice Address - Phone:706-359-4215
Practice Address - Fax:706-359-1662
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52010207Q00000X
CT61981207Q00000X
FLME137893207Q00000X
OH35.135090207Q00000X
GA046168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000871175EMedicaid
GA000871175HMedicaid
GA000871175HMedicaid
GAH05173Medicare UPIN