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General NPI Number Information
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NPI Number | 1184751745
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Entity Type | Individual
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Provider Name | MIRANDA DAWN WOOD PA
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 1222 TROTWOOD AVE SUITE 108
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City | COLUMBIA
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State | TN
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Zip | 38401-6436
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Country | US
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Telephone | 931-540-4140
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Fax | 931-540-4142
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Provider Business Mailing Address
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Address Line | 854 W JAMES CAMPBELL BLVD SUITE 303
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City | COLUMBIA
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State | TN
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Zip | 38401-4659
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Country | US
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Telephone | 931-540-4140
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Fax | 931-540-4143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1592
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License Number State | TN
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