Individual
JONATHAN LANCE UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3207 COUNTRY CLUB RD, VALDOSTA, GA 31605-1029
(229) 242-8480
(229) 241-0252
Mailing address
3207 COUNTRY CLUB RD, VALDOSTA, GA 31605-1029
(229) 242-8480
(229) 241-0252
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
002394
GA
Other
Enumeration date
11/09/2007
Last updated
06/23/2011
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