Provider Demographics
NPI:1447324108
Name:WOODY, WALTER RHETT III (MT)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RHETT
Last Name:WOODY
Suffix:III
Gender:M
Credentials:MT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4112
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35815-4112
Mailing Address - Country:US
Mailing Address - Phone:256-882-7275
Mailing Address - Fax:256-882-3853
Practice Address - Street 1:1428 WEATHERLY RD SE
Practice Address - Street 2:SUITE 109
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-1181
Practice Address - Country:US
Practice Address - Phone:256-882-7275
Practice Address - Fax:256-882-3853
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12353246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000096586Medicare PIN