Provider Demographics
NPI:1578260618
Name:WOOD, GRAYSON BLANDY III (DAC)
Entity Type:Individual
Prefix:
First Name:GRAYSON
Middle Name:BLANDY
Last Name:WOOD
Suffix:III
Gender:M
Credentials:DAC
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 461
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-0461
Mailing Address - Country:US
Mailing Address - Phone:401-788-1068
Mailing Address - Fax:
Practice Address - Street 1:750 BOSTON NECK RD STE 3
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-2926
Practice Address - Country:US
Practice Address - Phone:401-788-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist