Jonathan Stephen Wood, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

76998 Issued in GA

Practice address

4120 Five Forks Trickum Rd SW Ste 102
Lilburn, GA 30047-8975

Phone

(770) 923-6400

Fax

(770) 676-9876

NPI assigned

Aug 26, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Surgical Professional Services, LLC

  • Otolaryngology Physician
  • Atlanta, GA
  • NPI 1801224506
  NPD (past)
• Pediatric Associates of Lawrenceville LLC

  • Pediatric Adolescent Medicine Physician
  • Lawrenceville, GA
  • NPI 1770601593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1699055236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW STE 102",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300478975",
            "telephone_number": "770-923-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW STE 102",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300478975",
            "telephone_number": "770-923-6400",
            "fax_number": "770-676-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "JONATHAN",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-26",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "76998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA MEDICAL LICENSE",
            "identifier": "76998",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167J",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167N",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "1707074",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167L",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "06047829",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172167I",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judi Michelle Winbush, LAPC
• Ashley J Wingfield
• Joseph Edward Witek Jr., RPH
• Wood Eyecare, P.C.
• James M. Wood, O.D.
• Susan S. Wood, O.D.
• Libra Woods
• Anna Carolina Wheeler Wright
• Shaliyah Wright
• Changchun C Wu, MD

• Pediatrics Physician in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.