Provider Demographics
NPI:1437294485
Name:WOOD, ELAINE M (PHD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3080
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-0054
Mailing Address - Country:US
Mailing Address - Phone:706-219-2038
Mailing Address - Fax:706-219-2038
Practice Address - Street 1:226 W KYTLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1332
Practice Address - Country:US
Practice Address - Phone:706-219-1998
Practice Address - Fax:706-219-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY01744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000622256AMedicaid