Healthcare Provider Details

I. General information

NPI: 1831119304
Provider Name (Legal Business Name): GGD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 AVERA DR
FORT VALLEY GA
31030-5008
US

IV. Provider business mailing address

PO BOX 5048
MACON GA
31208-5048
US

V. Phone/Fax

Practice location:
  • Phone: 478-825-3317
  • Fax: 478-825-5499
Mailing address:
  • Phone: 478-825-3317
  • Fax: 478-825-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MICHAEL WAYNE EARLY SR.
Title or Position: OWNER
Credential: M.D.
Phone: 478-825-3317