Provider Demographics
NPI:1477576635
Name:WOOD, RICHARD E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1315 DELAUNEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2367
Mailing Address - Country:US
Mailing Address - Phone:706-987-8216
Mailing Address - Fax:706-987-8220
Practice Address - Street 1:94 MCCRARY RD
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-4558
Practice Address - Country:US
Practice Address - Phone:706-987-8216
Practice Address - Fax:706-987-8220
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-08-28
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Provider Licenses
StateLicense IDTaxonomies
GA19809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000176293HMedicaid
GA000176393CMedicaid
GA000176393FMedicaid
GA000176393GMedicaid
GA000176393EMedicaid
GA000176293HMedicaid