Healthcare Provider Details

I. General information

NPI: 1336522085
Provider Name (Legal Business Name): JOSEPH WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 PARKMAN AVE
SELMA AL
36701-5734
US

IV. Provider business mailing address

509 PARKMAN AVE
SELMA AL
36701-5734
US

V. Phone/Fax

Practice location:
  • Phone: 334-874-9064
  • Fax: 334-874-2633
Mailing address:
  • Phone: 334-874-9064
  • Fax: 334-874-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN-1-114276
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: