Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35.121625 | OH |
Y | 207VX0201X | Gynecologic Oncologist | 076530 | GA |
NPI | 1396094744 |
---|---|
Provider Name | Dr. John Joseph Wallbillich IV |
First Address | Columbus, OH 43210-1280 |
Second Address | Augusta, GA 30901-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 13/09/2016 |