Individual
MICHAEL DEOGRACIAS WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 W ACADEMY STREET, GAINESVILLE, GA 30501
(770) 282-8820
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6310
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116636Y
—
GA
Enumeration date
04/09/2009
Last updated
01/13/2021
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