Jeffery Shane Wood, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN011649 Issued in GA

Practice address

700 Wildwood Plantation Dr
Valdosta, GA 31602-3606

Phone

(229) 241-1010

Fax

(229) 293-0900

NPI assigned

Feb 14, 2007

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 11, 2016 through Jan 11, 2028

Medicare enrollment (NPD)

Enrolled

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.

• Smile Center Oral & Maxillofacial Surgery, LLC

  • Oral and Maxillofacial Pathology Dentistry
  • Valdosta, GA
  • NPI 1467345942
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992848659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 WILDWOOD PLANTATION DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316023606",
            "telephone_number": "229-241-1010",
            "fax_number": "229-293-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WILDWOOD PLANTATION DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316023606",
            "telephone_number": "229-241-1010",
            "fax_number": "229-293-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "JEFFERY",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN011649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000752067A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "582312881",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia M Wittenborn, LCSW
• Anna Wolford, PP
• Robertus Wolters, RPT
• Kathryn Marie Woltz, PA-C
• Bryan Wood, RBT
• Todd Woodard, PHARM.D.
• Shellby Lynne Woodrum, MED CCC-SLP
• Andrew D Woods, DPM
• Thomas Franklin Woods Jr., AA
• Bolan P Woodward, MD

• Oral and Maxillofacial Surgery (Dentist) in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.