Healthcare Provider Details

I. General information

NPI: 1922748474
Provider Name (Legal Business Name): WALTER GRIFFIN WOOD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 TYSON AVE
PARIS TN
38242-4544
US

IV. Provider business mailing address

228 NANCE CIR
PARIS TN
38242-5698
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax:
Mailing address:
  • Phone: 731-336-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5070
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC151
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: