Organization
MEDFAST 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARDO A KLUG M.D. (PRESIDENT)
(912) 285-3157
Entity
Organization
Contact information
Practice address
1405 ALICE ST, WAYCROSS, GA 31501-4528
(912) 285-3157
(912) 283-2051
Mailing address
1405 ALICE ST, WAYCROSS, GA 31501-4528
(912) 285-3157
(912) 283-2051
Taxonomy
Speciality
Code
Description
License number
State
209800000X
Legal Medicine (M.D./D.O.) Physician
Primary
031778
GA
Other
Enumeration date
06/08/2006
Last updated
08/22/2020
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