Provider Demographics
NPI:1457757056
Name:WOOD, SALLY EDWARDS (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:EDWARDS
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 NEWLAND CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6687
Mailing Address - Country:US
Mailing Address - Phone:706-504-2227
Mailing Address - Fax:
Practice Address - Street 1:237 NEWLAND CIR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-6687
Practice Address - Country:US
Practice Address - Phone:706-504-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170191163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant