Provider Demographics
NPI:1902908254
Name:WOODS, WALTER ROBERT (DPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ROBERT
Last Name:WOODS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 22ND AVE S
Mailing Address - Street 2:ROOM 1815 TVC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220
Mailing Address - Country:US
Mailing Address - Phone:615-322-4775
Mailing Address - Fax:615-936-1893
Practice Address - Street 1:1211 22ND AVE S
Practice Address - Street 2:ROOM 1815 TVC
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220
Practice Address - Country:US
Practice Address - Phone:615-322-4775
Practice Address - Fax:615-936-1893
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPHARMACIST LICENSEOther4754