Provider Demographics
NPI:1649234725
Name:WOOD, ROBERT M (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 SHADOW LOCH DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7003
Mailing Address - Country:US
Mailing Address - Phone:770-377-3423
Mailing Address - Fax:864-512-1823
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:864-512-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1227367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052209Medicaid
GA000550943JMedicaid
SCAN0936Medicaid
GA000550943HMedicaid
GA000550943JMedicaid
SC5965Medicare PIN
SCAN0936Medicaid
GA511I430164Medicare PIN
SC430066853Medicare PIN