Provider Demographics
NPI:1205360120
Name:WOOD, MICHELLE ASHLEY (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ASHLEY
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WELCH RD STE 403
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1804
Mailing Address - Country:US
Mailing Address - Phone:506-327-8778
Mailing Address - Fax:
Practice Address - Street 1:5755 SHATTALON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1332
Practice Address - Country:US
Practice Address - Phone:336-784-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30874101YA0400X
NC2023-01599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)