=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245220128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN P. ERDMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2005
-----------------------------------------------------
Last Update Date | 06/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 BATTLEWOOD DR
-----------------------------------------------------
City | FORT OGLETHORPE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30742-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-861-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 BATTLEWOOD DR
-----------------------------------------------------
City | FT OGLETHORPE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30742-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-861-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD0000024929
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 035251
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------