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General NPI Number Information
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NPI Number | 1225245798
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Entity Type | Organization
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Legal Business Name | JOHN W DEVINE, MD, PC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 209 PENDLETON DR
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City | VALDOSTA
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State | GA
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Zip | 31602-1729
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Country | US
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Telephone | 229-259-4602
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Fax | 229-249-5063
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Provider Business Mailing Address
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Address Line | PO BOX 162055
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City | ATLANTA
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State | GA
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Zip | 30321-2055
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Country | US
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Telephone | 229-259-4602
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Fax | 229-249-5063
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Authorized Official
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Title or Position | OWNER
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Name | JOHN W DEVINE
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Credential | MD
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Telephone | 229-259-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 027048
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License Number State | GA
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