Individual
TISHA J WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
61 MADISON ST, ROANOKE RAPIDS, NC 27870-1854
(125) 232-6577
Mailing address
61 MADISON ST, ROANOKE RAPIDS, NC 27870-1854
(125) 232-6577
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
000038608717
NC
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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