Healthcare Provider Details

I. General information

NPI: 1851778823
Provider Name (Legal Business Name): JEFFERY M BUTLER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 JOHNSON ST
HAZLEHURST GA
31539-6243
US

IV. Provider business mailing address

PO BOX 1166
BAXLEY GA
31515-1166
US

V. Phone/Fax

Practice location:
  • Phone: 800-367-0816
  • Fax: 912-705-6867
Mailing address:
  • Phone: 912-705-6866
  • Fax: 912-705-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: JEFFERY MILES BUTLER
Title or Position: OWNER
Credential: MD
Phone: 912-278-3510