Individual
DR. JOHN DAVID NORTHUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12345 MERCY BLVD, SAVANNAH, GA 31419-3436
(912) 927-3046
(912) 925-0597
Mailing address
12345 MERCY BLVD, SAVANNAH, GA 31419-3436
(912) 927-3046
(912) 925-0597
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
016651
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000018092A
—
GA
01
—
110164346
RAILROAD MEDICARE
GA
01
—
581263266
UNITED HEALTHCARE
GA
Enumeration date
04/13/2007
Last updated
01/03/2014
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