Healthcare Provider Details

I. General information

NPI: 1790355972
Provider Name (Legal Business Name): SAMANTHA WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 STEPHENSON AVE STE 206
SAVANNAH GA
31405-5841
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 702
NASHVILLE TN
37217-2679
US

V. Phone/Fax

Practice location:
  • Phone: 912-244-4031
  • Fax: 615-815-1946
Mailing address:
  • Phone: 153-614-0006
  • Fax: 615-815-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: