Provider Demographics
NPI:1659636728
Name:WOOD, TINA MICHELE (CPHT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELE
Last Name:WOOD
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 SILVER HILL TER SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-6710
Mailing Address - Country:US
Mailing Address - Phone:678-787-4602
Mailing Address - Fax:
Practice Address - Street 1:1275 CAROLINE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2705
Practice Address - Country:US
Practice Address - Phone:404-260-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC002492183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician