Healthcare Provider Details

I. General information

NPI: 1942368576
Provider Name (Legal Business Name): BARRY EDWARD WOOD JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 MCKENZIE GRADE
GEORGIANA AL
36033-5819
US

IV. Provider business mailing address

14705 MCKENZIE GRADE
GEORGIANA AL
36033-5819
US

V. Phone/Fax

Practice location:
  • Phone: 404-272-9894
  • Fax:
Mailing address:
  • Phone: 404-272-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN177465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: