Organization
DAVID W RETTERBUSH MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WILLIAM RETTERBUSH MD (OWNER PRESIDENT)
(229) 244-0034
Entity
Organization
Contact information
Practice address
403 COWART AVE, VALDOSTA, GA 31602-2635
(229) 244-0034
(229) 244-1871
Mailing address
PO BOX 3638, VALDOSTA, GA 31604-3638
(229) 244-0034
(229) 244-1871
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
19642
KY
208600000X
Surgery Physician
Primary
20145
GA
208600000X
Surgery Physician
51883
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000193278A
—
GA
01
—
020022209
RAILROAD MEDICARE
GA
01
—
511G700378
GROUP PROVIDER TRANSACTION ACCESS NUMBER ( PTAN)
GA
01
—
525023
BS OF GA
GA
Enumeration date
09/20/2005
Last updated
06/19/2008
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