Richard E Wood Jr., MD
Individual provider Active NPI Family Medicine Physician · Fortson, GA
NPI 1477576635 · NPPES record last updated Aug 28, 2009
Key facts
- NPI
- 1477576635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 19809 (GA)
- Practice address
- 94 McCrary Rd
Fortson, GA 31808-4558 - Phone
- (706) 987-8216
- Fax
- (706) 987-8220
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019809 | GA | MD | Pharmacist |
| 19809 | GA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 19809 | GA | Yes |
Addresses
Primary practice location
94 McCrary Rd
Fortson, GA 31808-4558
Mailing address
1315 Delauney Ave
Suite 201
Columbus, GA 31901-2367
Phone (706) 987-8216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000176293H | Medicaid | GA | |
| 000176393C | Medicaid | GA | |
| 000176393F | Medicaid | GA | |
| 000176393G | Medicaid | GA | |
| 000176393E | Medicaid | GA |
Other providers in Fortson, GA
- Valerie A Sparks
- Lavon Thurman
- Tera Dawn Timmons
- Valley Healthcare System Inc
- Robert G. Wallace
- Laurie Wylie
All providers in Fortson, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.