Provider Demographics
NPI:1033577879
Name:WOOD, JACLYN (NP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-428-4475
Mailing Address - Fax:770-426-1499
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-428-4475
Practice Address - Fax:770-426-1499
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN205800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily