Basic Information
| Provider Information | |||||||||
| NPI: | 1295801355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | EARL | ||||||||
| MiddleName: | CLINTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 366 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296780926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643646380 | ||||||||
| FaxNumber: | 8338539422 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 RAM CAT ALY | ||||||||
| Address2: | SENECA | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296783244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648884445 | ||||||||
| FaxNumber: | 8648884345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34204 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 342043 | 05 | SC | MEDICAID |