Organization
DERMATOLOGY SPECIALISTS OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON R WARD MD (MD/OWNER)
(850) 233-3376
Entity
Organization
Contact information
Practice address
658 N CHASE STREET UNIT 102, ATHENS, GA 30601
(877) 231-3376
(850) 522-8354
Mailing address
2505 HARRISON AVE, PANAMA CITY, FL 32405-4464
(877) 231-3376
(850) 522-8354
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
18041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000084961B
—
GA
01
—
10059273
AMERIGROUP
GA
01
—
30926
WELLCARE
GA
Enumeration date
02/05/2007
Last updated
09/02/2022
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