Healthcare Provider Details

I. General information

NPI: 1699718056
Provider Name (Legal Business Name): JOHN W SOUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 HILLCREST PKWY STE 104
DUBLIN GA
31021-4258
US

IV. Provider business mailing address

1101 HILLCREST PKWY STE L PMB #325
DUBLIN GA
31021-3581
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1463
  • Fax: 478-272-1465
Mailing address:
  • Phone: 478-272-1463
  • Fax: 478-272-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39475
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number39475
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: