Provider Demographics
NPI:1235320169
Name:WOODSFELLOW, DAVID MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:WOODSFELLOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HWY
Mailing Address - Street 2:STE 295
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2124
Mailing Address - Country:US
Mailing Address - Phone:404-325-3401
Mailing Address - Fax:404-325-2897
Practice Address - Street 1:2801 BUFORD HWY
Practice Address - Street 2:STE 295
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2124
Practice Address - Country:US
Practice Address - Phone:404-325-3401
Practice Address - Fax:404-325-3401
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical