Provider Demographics
NPI:1902509169
Name:WOOD, GRIFFITH EDWIN
Entity Type:Individual
Prefix:
First Name:GRIFFITH
Middle Name:EDWIN
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 CATAWBA RD
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-4806
Mailing Address - Country:US
Mailing Address - Phone:540-521-2365
Mailing Address - Fax:
Practice Address - Street 1:600 JOHN PAUL JONES CIR.
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2370
Practice Address - Country:US
Practice Address - Phone:757-953-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider