MEDICARE: DENNIS WOOD PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1038	SC
2	363A00000X	Physician Assistant	3465	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164480935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS WOOD PAC

Provider Business Mailing Address
First Line	:	40 COWETA CT
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30540-0619
Country	:	US
Telephone Number	:	706-276-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	178A HOSPITAL RD
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3139
Country	:	US
Telephone Number	:	706-745-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	01/13/2015

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Directions to “ DENNIS WOOD PAC” Practice Location

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