Provider Demographics
NPI:1437129871
Name:WOOD, BRUCE A (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:290 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:678-284-6300
Mailing Address - Fax:678-284-6336
Practice Address - Street 1:259 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3769
Practice Address - Country:US
Practice Address - Phone:770-957-8666
Practice Address - Fax:770-957-0375
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-03-16
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Provider Licenses
StateLicense IDTaxonomies
GA023516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000240699EMedicaid
F87008Medicare UPIN
GA08BBSSTMedicare PIN