Provider Demographics
NPI:1932283199
Name:WOOD, JAMES M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:2006-10-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1148-T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01209642Medicare PIN