MEDICARE: TERRY W. WOOD M.D.

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	207R00000X	Internal Medicine Physician	036636	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52409180	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316904220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY W. WOOD M.D.

Provider Business Mailing Address
First Line	:	1340 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-3016
Country	:	US
Telephone Number	:	404-627-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-3016
Country	:	US
Telephone Number	:	404-627-4259
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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