Individual
DR. JEFFERY SHANE WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
700 WILDWOOD PLANTATION DR, VALDOSTA, GA 31602-3606
(229) 241-1010
(229) 293-0900
Mailing address
700 WILDWOOD PLANTATION DR, VALDOSTA, GA 31602-3606
(229) 241-1010
(229) 293-0900
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN011649
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000752067A
—
GA
01
—
582312881
TAX ID
GA
Enumeration date
02/14/2007
Last updated
07/08/2007
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