Active NPI
George R Woodbury Sr., MD
- Specialist
- Mountain Home, AR
National Provider Identifier
1114097938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD3499
- Practice address
- 1200 Highway 201 N
Mountain Home, AR 72653-2440 - Phone
- (870) 425-0672
- Fax
- (870) 425-0796
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD3499 | TN | Primary |
Addresses
Primary practice location
1200 Highway 201 N
Mountain Home, AR 72653-2440
Mailing address
PO Box 1716
Mountain Home, AR 72654-1716
Phone (901) 682-5606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100728000499 | AR | Practitioner - Ophthalmology | 4880727817 | Practice locations: Mountain Home, AR; Heber Springs, AR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD3499 | TN | MD | Specialist |
| 3499 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463961600000",
"number": "1114097938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1716",
"city": "MOUNTAIN HOME",
"state": "AR",
"postal_code": "726541716",
"telephone_number": "901-682-5606",
"fax_number": "901-682-7853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 HIGHWAY 201 N",
"city": "MOUNTAIN HOME",
"state": "AR",
"postal_code": "726532440",
"telephone_number": "870-425-0672",
"fax_number": "870-425-0796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODBURY",
"first_name": "GEORGE",
"middle_name": "R",
"name_suffix": "Sr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2016-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TN",
"license": "MD3499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.