Individual
DR. JOHN P OUDERKIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
735 PIEDMONT AVE NE, ATLANTA, GA 30308-1416
(404) 588-4680
(404) 588-4692
Mailing address
8390 CHAMPIONS GATE BLVD, SUITE 215, CHAMPIONS GATE, FL 33896-8310
(407) 390-1677
(407) 390-1765
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
049992
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000926318A
—
GA
01
—
2647814
AETNA HMO
GA
01
—
440003559
RAILROAD MEDICARE
GA
01
—
453538
CHAMPUS
GA
01
—
7439283
US HEALTH
GA
01
—
8625897001
CIGNA HMO
GA
Enumeration date
07/29/2005
Last updated
07/27/2016
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