Provider Demographics
NPI:1295801355
Name:WOOD, EARL CLINTON III (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:CLINTON
Last Name:WOOD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0926
Mailing Address - Country:US
Mailing Address - Phone:864-364-6380
Mailing Address - Fax:833-853-9422
Practice Address - Street 1:106 RAM CAT ALY
Practice Address - Street 2:SENECA
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3244
Practice Address - Country:US
Practice Address - Phone:864-888-4445
Practice Address - Fax:864-888-4345
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34204207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC342043Medicaid
SCPTAN AA804Medicare PIN
KY64234347Medicaid
KY1897801Medicare PIN
SC8768Medicare PIN
SCGP4697Medicaid