Provider Demographics
NPI:1295898450
Name:JAMES H WOOD MD PC
Entity type:Organization
Organization Name:JAMES H WOOD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-350-5501
Mailing Address - Street 1:3903 SOUTH COBB DRIVE SE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6342
Mailing Address - Country:US
Mailing Address - Phone:770-431-8007
Mailing Address - Fax:770-431-5010
Practice Address - Street 1:3903 SOUTH COBB DRIVE SE
Practice Address - Street 2:SUITE 235
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6342
Practice Address - Country:US
Practice Address - Phone:770-431-8007
Practice Address - Fax:770-431-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015644207T00000X
GA022916207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00222769CMedicaid
GA00222769CMedicaid
GA312483393CMedicare ID - Type Unspecified