Provider Demographics
NPI:1609512748
Name:WOOD, MARK (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:GA
Mailing Address - Zip Code:30725-2742
Mailing Address - Country:US
Mailing Address - Phone:503-536-5317
Mailing Address - Fax:
Practice Address - Street 1:1100 E 3RD ST STE G-102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2241
Practice Address - Country:US
Practice Address - Phone:503-536-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty