Healthcare Provider Details

I. General information

NPI: 1134713621
Provider Name (Legal Business Name): DAVID WILLIAM WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 BIG A RD
TOCCOA GA
30577-6028
US

IV. Provider business mailing address

104 FAIRGROUNDS RD
TOCCOA GA
30577-7214
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8711
  • Fax:
Mailing address:
  • Phone: 706-886-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032725
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: