Individual
MR. JORDAN LEE WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
308 COLISEUM DR STE 120, MACON, GA 31217-3859
(478) 745-6130
(478) 745-4443
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(478) 745-6130
(478) 745-4443
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN231069
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003210385A
—
GA
05
—
003210385B
—
GA
01
—
G06315B
MEDICARE PTAN
GA
Enumeration date
07/05/2017
Last updated
08/19/2020
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