Provider Demographics
NPI:1063621100
Name:WOOD, BEVERLY A (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAUREL BAY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:803-896-2281
Practice Address - Street 1:4344 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4010
Practice Address - Country:US
Practice Address - Phone:803-896-8843
Practice Address - Fax:803-896-2281
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC154602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry