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General NPI Number Information
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NPI Number | 1689908873
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Entity Type | Individual
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Provider Name | VANCE T WOOD PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 462 MEMORY LN SUITE 110
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City | DAWSONVILLE
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State | GA
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Zip | 30534-4314
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Country | US
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Telephone | 706-265-1357
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Fax | 706-265-1406
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Provider Business Mailing Address
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Address Line | 462 MEMORY LN SUITE 110
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City | DAWSONVILLE
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State | GA
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Zip | 30534-4314
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Country | US
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Telephone | 706-265-1357
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Fax | 706-265-1406
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3014
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License Number State | GA
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