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General NPI Number Information
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NPI Number | 1659806248
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Entity Type | Organization
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Legal Business Name | BLUFF DRIVE MEDICAL
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 954 MEMORIAL DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-2334
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Country | US
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Telephone | 678-897-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 954 MEMORIAL DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-2334
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Country | US
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Telephone | 678-897-9577
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JOHN D FILSON
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Credential | PA
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Telephone | 678-897-9577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 003951
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License Number State | GA
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