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General NPI Number Information
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NPI Number | 1679520753
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Entity Type | Organization
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Legal Business Name | WAYCROSS ORTHOPAEDICS, P.C.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2002 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6210
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Country | US
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Telephone | 912-283-8444
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Fax | 912-283-7132
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Provider Business Mailing Address
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Address Line | PO BOX 2265
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City | WAYCROSS
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State | GA
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Zip | 31502-2265
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Country | US
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Telephone | 912-283-8444
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Fax | 912-283-7132
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | MRS. CHERYL B. TATUM
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Credential |
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Telephone | 912-283-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28435
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License Number State | GA
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