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Individual

JOHN W. DESIMONE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
611 E WASHINGTON AVE, ASHBURN, GA 31714-5315
(229) 567-3407
Mailing address
907 18TH ST E, SUITE 150, TIFTON, GA 31794-3643
(229) 353-3422

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
019930
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000203365C
GA
01
019930
LICENSE NUMBER
GA
Enumeration date
11/01/2006
Last updated
11/11/2013
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