Healthcare Provider Details

I. General information

NPI: 1356036180
Provider Name (Legal Business Name): TODD MARTIN WOOD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 10TH AVE
COLUMBUS GA
31901-1529
US

IV. Provider business mailing address

1909 WILDWOOD AVE
COLUMBUS GA
31906-1458
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1604
  • Fax:
Mailing address:
  • Phone: 706-587-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100786
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: