Basic Information
| Provider Information | |||||||||
| NPI: | 1891807996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 WHIPPETT LN | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377166298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659741902 | ||||||||
| FaxNumber: | 8659741259 | ||||||||
| Practice Location | |||||||||
| Address1: | 117A NEYLAND THOMPSON SPORTS CTR | ||||||||
| Address2: | 1704 JOHNNY MAJORS DRIVE | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379960001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659741902 | ||||||||
| FaxNumber: | 8659741259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0000000138 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.