Individual
JOHN BURTON DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 ARLINGTON DR, VIDALIA, GA 30474-0645
(912) 538-0830
Mailing address
300 ARLINGTON DR, PO BOX 645, VIDALIA, GA 30475
(912) 538-0830
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01655
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01655
LICENSE
GA
Enumeration date
01/22/2007
Last updated
03/07/2023
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