Provider Demographics
NPI:1891807996
Name:WOOD, JEFFERY DOUGLAS (ATC)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DOUGLAS
Last Name:WOOD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:105 WHIPPETT LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6298
Mailing Address - Country:US
Mailing Address - Phone:865-974-1902
Mailing Address - Fax:865-974-1259
Practice Address - Street 1:117A NEYLAND THOMPSON SPORTS CTR
Practice Address - Street 2:1704 JOHNNY MAJORS DRIVE
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-1902
Practice Address - Fax:865-974-1259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN00000001382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer