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General NPI Number Information
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NPI Number | 1548260508
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Entity Type | Individual
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Provider Name | JOHN P OUDERKIRK MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 735 PIEDMONT AVE NE
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City | ATLANTA
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State | GA
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Zip | 30308-1416
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Country | US
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Telephone | 404-588-4680
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Fax | 404-588-4692
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Provider Business Mailing Address
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Address Line | 8390 CHAMPIONS GATE BLVD SUITE 215
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8310
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Country | US
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Telephone | 407-390-1677
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Fax | 407-390-1765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 049992
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License Number State | GA
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