Organization
JOHN J LAND IV PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN J LAND IV DPM (PRESIDENT)
(706) 278-5558
Entity
Organization
Contact information
Practice address
1107 BROADRICK DR, DALTON, GA 30720-2592
(706) 278-5558
(706) 278-6334
Mailing address
1107 BROADRICK DR, DALTON, GA 30720-2592
(706) 278-5558
(706) 278-6334
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD000679
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000828385A
—
GA
01
—
1440694
UMWA
GA
01
—
3124909
BLUE CROSS/ BLUE SHIELD
TN
01
—
3351905
MEDICARE
TN
01
—
480027427
RAIL ROAD MEDICARE
GA
01
—
52432145
BLUE CROSS/ BLUE SHIELD
GA
Enumeration date
06/03/2008
Last updated
06/03/2008
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