Individual
JOHN DAVID ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2704 N OAK ST, BLDG O, VALDOSTA, GA 31602-1744
(229) 247-2350
(229) 247-6826
Mailing address
2704 N OAK ST, BLDG O, VALDOSTA, GA 31602-1744
(229) 247-2350
(229) 247-6826
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
GA021630
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00229919C
—
GA
01
—
11D0265529
CLIA
—
05
—
2641658-01
—
FL
Enumeration date
07/29/2005
Last updated
12/17/2009
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