Provider Demographics
NPI:1740409499
Name:WOOD, SUSAN S (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3050 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1807
Mailing Address - Country:US
Mailing Address - Phone:770-978-2990
Mailing Address - Fax:770-978-2993
Practice Address - Street 1:3050 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 112
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1807
Practice Address - Country:US
Practice Address - Phone:770-978-2990
Practice Address - Fax:770-978-2993
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1145-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMW0154106OtherDEA #