Healthcare Provider Details

I. General information

NPI: 1902509169
Provider Name (Legal Business Name): GRIFFITH EDWIN WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JOHN PAUL JONES CIR.
PORTSMOUTH VA
23708-2370
US

IV. Provider business mailing address

9293 CATAWBA RD
TROUTVILLE VA
24175-4806
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-0258
  • Fax:
Mailing address:
  • Phone: 540-521-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: