Provider Demographics
NPI:1689908873
Name:WOOD, VANCE T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:T
Last Name:WOOD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:462 MEMORY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4314
Mailing Address - Country:US
Mailing Address - Phone:706-265-1357
Mailing Address - Fax:706-265-1406
Practice Address - Street 1:462 MEMORY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-4314
Practice Address - Country:US
Practice Address - Phone:706-265-1357
Practice Address - Fax:706-265-1406
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA307689258AMedicaid