Provider Demographics
NPI:1144205253
Name:WOOD, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2051-B HAMILL ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4653
Mailing Address - Country:US
Mailing Address - Phone:423-756-8871
Mailing Address - Fax:423-475-8976
Practice Address - Street 1:2051-B HAMILL ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4653
Practice Address - Country:US
Practice Address - Phone:423-756-8871
Practice Address - Fax:423-475-8976
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35915207R00000X
NC38466207R00000X
AL12563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I111415Medicare PIN
TN3870681Medicare ID - Type Unspecified