Provider Demographics
NPI:1396764429
Name:WOOD, JOHN L (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2490 RIVERSIDE DR
Mailing Address - Street 2:STE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1787
Mailing Address - Country:US
Mailing Address - Phone:478-633-6633
Mailing Address - Fax:478-633-4295
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:MSC 142
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-7707
Practice Address - Fax:478-633-7879
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-11-24
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Provider Licenses
StateLicense IDTaxonomies
SC26979207P00000X
GA059239207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA602834254DMedicaid