Individual
DR. JOHN JOSEPH LAND IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
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
DPM0000000417
TN
213E00000X
Podiatrist
Primary
POD000679
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000828385A
—
GA
01
—
1440694
UMWA
—
01
—
3124909
BCBS
TN
01
—
52432145
BC BS
GA
Enumeration date
10/27/2006
Last updated
02/27/2020
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