Provider Demographics
NPI:1396359832
Name:WOOD, JOHN GLEN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GLEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 RAILROAD LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24991-4902
Mailing Address - Country:US
Mailing Address - Phone:304-992-5074
Mailing Address - Fax:
Practice Address - Street 1:257 RAILROAD LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:WV
Practice Address - Zip Code:24991-4902
Practice Address - Country:US
Practice Address - Phone:304-992-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant