MEDICARE: CHARLES E WOOD PA-C

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	363AS0400X	Surgical Physician Assistant	PA2616	FL
2	363A00000X	Physician Assistant	PA2616	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970009795	OTHER		RAILROAD MEDICARE
3	P00088264	OTHER		RAILROAD MEDICARE

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	:	1235193400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E WOOD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 746654
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6654
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-393-7603

Provider Business Practice Location Address
First Line	:	1301 PALM AVE STE 600
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8432
Country	:	US
Telephone Number	:	904-202-7300
Fax Number	:	904-202-7433

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/26/2024

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Directions to “ CHARLES E WOOD PA-C” Practice Location

Language	Start Address	Practice Location

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