Provider Demographics
NPI:1104983410
Name:WOOD, VIRGINIA SUTTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:SUTTON
Last Name:WOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3732
Mailing Address - Country:US
Mailing Address - Phone:404-414-8086
Mailing Address - Fax:678-392-3863
Practice Address - Street 1:240 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3732
Practice Address - Country:US
Practice Address - Phone:404-414-8086
Practice Address - Fax:678-392-3863
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFKTMedicare ID - Type Unspecified