Provider Demographics
NPI:1134116916
Name:WOOD, GEORGE W II (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:WOOD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-682-5642
Mailing Address - Fax:901-683-5527
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 309
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5213
Practice Address - Country:US
Practice Address - Phone:901-682-5642
Practice Address - Fax:901-683-5527
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11237207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000130Medicare PIN
TNB59424Medicare UPIN
TNB59424Medicare UPIN