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General NPI Number Information
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NPI Number | 1891373288
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Entity Type | Individual
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Provider Name | CRYSTAL L WOOD BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 163 E TOLLISON ST
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City | BAXLEY
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State | GA
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Zip | 31513-0120
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Country | US
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Telephone | 912-367-9841
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Fax |
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Provider Business Mailing Address
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Address Line | 108 HATTON STILL RD LOT 4
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City | HAZLEHURST
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State | GA
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Zip | 31539-4371
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Country | US
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Telephone | 912-551-2632
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Fax |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN204542
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License Number State | GA
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