Healthcare Provider Details

I. General information

NPI: 1275475865
Provider Name (Legal Business Name): IMANI T WOOD DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OSAN AFB VTF BLDG 766 SONGTAN BLVD
APO AP
96266
US

IV. Provider business mailing address

OSAN AFB VTF BLDG 766 SONGTAN BLVD
APO AP
96266
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-6937
  • Fax:
Mailing address:
  • Phone: 315-784-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET011071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: