1225245798 NPI number — JOHN W DEVINE, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225245798 NPI number — JOHN W DEVINE, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN W DEVINE, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225245798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162055
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30321-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-259-4602
Provider Business Mailing Address Fax Number:
229-249-5063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 PENDLETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31602-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-259-4602
Provider Business Practice Location Address Fax Number:
229-249-5063
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVINE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
229-259-4602

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  027048 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 268851400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000311066A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235533 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 332092 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com