Healthcare Provider Details

I. General information

NPI: 1144301201
Provider Name (Legal Business Name): COLLEEN NORMA WOOD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 COBB PARKWAY NORTH SUITE 101
MARIETTA GA
30060
US

IV. Provider business mailing address

4616 GILHAMS RD NE
ROSWELL GA
30075-1908
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-4804
  • Fax:
Mailing address:
  • Phone: 404-863-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006326
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: