Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 37277 | GA |
NPI | 1043300999 |
---|---|
Provider Name | Robert A Ludwick |
First Address | Fitzgerald, GA 31750-1447 |
Second Address | Fitzgerald, GA 31750-8858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000566948E | (05) | GA |
D09164 | (02) | GA |