Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 020493 | GA |
NPI | 1013950120 |
---|---|
Provider Name | Dr. John I. Waldrop |
First Address | Fortson, GA 31808-0370 |
Second Address | Columbus, GA 31909-3540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C75539 | (02) |