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General NPI Number Information
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NPI Number | 1356500573
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Entity Type | Organization
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Legal Business Name | JOHN J LAND IV PC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1107 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2592
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Country | US
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Telephone | 706-278-5558
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Fax | 706-278-6334
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Provider Business Mailing Address
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Address Line | 1107 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2592
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Country | US
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Telephone | 706-278-5558
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Fax | 706-278-6334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN J LAND IV
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Credential | DPM
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Telephone | 706-278-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD000679
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License Number State | GA
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