Healthcare Provider Details

I. General information

NPI: 1568411338
Provider Name (Legal Business Name): BRIAN J. LUDWIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MARGIE DR
WARNER ROBINS GA
31088-7818
US

IV. Provider business mailing address

301 MARGIE DR
WARNER ROBINS GA
31088-7818
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-1153
  • Fax: 478-971-1171
Mailing address:
  • Phone: 478-971-1153
  • Fax: 478-971-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number48724
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number066351
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD.29445
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number01067922A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number066351
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: