Provider Demographics
NPI:1093723454
Name:WOOD, HENRY G (PA)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3224
Mailing Address - Country:US
Mailing Address - Phone:706-509-3278
Mailing Address - Fax:706-509-4608
Practice Address - Street 1:310 W 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2639
Practice Address - Country:US
Practice Address - Phone:706-232-1503
Practice Address - Fax:706-235-3684
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA001241363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00171311LMedicaid
GA97BBDQGMedicare PIN
GA00171311LMedicaid