Individual
DR. JONATHAN STEPHEN WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4120 FIVE FORKS TRICKUM RD SW STE 102, LILBURN, GA 30047-8975
(770) 923-6400
(770) 676-9876
Mailing address
4120 FIVE FORKS TRICKUM RD SW STE 102, LILBURN, GA 30047-8975
(770) 923-6400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
76998
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003172167
—
GA
05
—
003172167H
—
GA
05
—
003172167I
—
GA
05
—
003172167J
—
GA
05
—
003172167K
—
GA
05
—
003172167L
—
GA
05
—
003172167M
—
GA
05
—
003172167N
—
GA
01
—
06047829
AMERIGROUP
GA
01
—
1707074
WELLCARE
GA
01
—
76998
GEORGIA MEDICAL LICENSE
GA
Enumeration date
08/26/2011
Last updated
05/31/2023
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