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Organization
WAYCROSS FAMILY PRACTICE
Active
Organization
WAYCROSS FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON JOHNSON (OFFICE MGR)
(912) 283-7220
Entity
Organization
Contact information
Practice address
1507 ALICE ST, WAYCROSS, GA 31501-4530
(912) 283-7220
(912) 283-7026
Mailing address
1507 ALICE ST, WAYCROSS, GA 31501-4530
(912) 283-7220
(912) 283-7026
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB0726
RAILROAD MEDICARE
GA
Enumeration date
04/27/2006
Last updated
01/07/2013
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