Provider Demographics
NPI:1578734034
Name:WOOD, JACOLA A (BS)
Entity Type:Individual
Prefix:
First Name:JACOLA
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 STRATTON PLACE DR # A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4123
Mailing Address - Country:US
Mailing Address - Phone:423-544-1787
Mailing Address - Fax:
Practice Address - Street 1:1426 STRATTON PLACE DR # A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4123
Practice Address - Country:US
Practice Address - Phone:423-544-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker