Individual
MIRANDA DAWN WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1222 TROTWOOD AVE, SUITE 108, COLUMBIA, TN 38401-6436
(931) 540-4140
(931) 540-4142
Mailing address
854 W JAMES CAMPBELL BLVD, SUITE 303, COLUMBIA, TN 38401-4659
(931) 540-4140
(931) 540-4143
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1592
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1505712
—
TN
05
—
3710089
—
TN
01
—
4191519
BCBST
—
Enumeration date
02/28/2007
Last updated
04/06/2015
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