Provider Demographics
NPI:1699747576
Name:WOODARD, BRETT HOUGHTON (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:HOUGHTON
Last Name:WOODARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5803
Mailing Address - Country:US
Mailing Address - Phone:800-779-4858
Mailing Address - Fax:864-231-6448
Practice Address - Street 1:404 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5803
Practice Address - Country:US
Practice Address - Phone:864-226-1558
Practice Address - Fax:864-231-6448
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20640207ZB0001X, 207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000355693AMedicaid
SC106673Medicaid
SC106673Medicaid
GA000355693AMedicaid
220007869Medicare PIN