Healthcare Provider Details

I. General information

NPI: 1528116019
Provider Name (Legal Business Name): JOHN WILLIAM LEDWITCH III CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N OAK STREET EXT
VALDOSTA GA
31605-1014
US

IV. Provider business mailing address

3301 N OAK STREET EXT
VALDOSTA GA
31605
US

V. Phone/Fax

Practice location:
  • Phone: 229-242-6061
  • Fax: 229-242-6151
Mailing address:
  • Phone: 229-242-6061
  • Fax: 229-242-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP196360
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: