Individual
JOSEPH VANDEWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
114 IDLE HOUR DR, MACON, GA 31210-4434
(478) 955-4358
Mailing address
114 IDLE HOUR DR, MACON, GA 31210-4434
(478) 955-4358
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
022658
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
022658
GA
Other
Enumeration date
05/05/2017
Last updated
05/05/2017
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