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General NPI Number Information
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NPI Number | 1255529251
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Entity Type | Organization
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Legal Business Name | N GA NEUROSURGICAL ASSOC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD SUITE 390
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-8708
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Country | US
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Telephone | 770-962-0758
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Fax | 770-822-4559
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Provider Business Mailing Address
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Address Line | 500 MEDICAL CENTER BLVD SUITE 390
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-8708
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Country | US
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Telephone | 770-962-0758
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Fax | 770-822-4559
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES O WOOD
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Credential | MD
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Telephone | 770-962-0758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 027263
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License Number State | GA
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