Provider Demographics
NPI:1740271154
Name:WOOD, KATHY DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:DIANE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DYKES ST SW
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-1837
Mailing Address - Country:US
Mailing Address - Phone:478-934-8855
Mailing Address - Fax:478-934-8855
Practice Address - Street 1:169 WEST DYKES ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-1837
Practice Address - Country:US
Practice Address - Phone:478-934-8855
Practice Address - Fax:478-934-8855
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor