Healthcare Provider Details

I. General information

NPI: 1457757056
Provider Name (Legal Business Name): SALLY EDWARDS WOOD RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2014
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 NEWLAND CIR
EVANS GA
30809-6687
US

IV. Provider business mailing address

237 NEWLAND CIR
EVANS GA
30809-6687
US

V. Phone/Fax

Practice location:
  • Phone: 706-504-2227
  • Fax:
Mailing address:
  • Phone: 706-504-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN170191
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: