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NPI Code Detail

MEDICARE: JOHN WILLIAM DEVINE MD

MEDICARE: JOHN WILLIAM DEVINE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0203XTherapeutic Radiology Physician027048GA
22085R0203XTherapeutic Radiology Physician0042409FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578566964
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN WILLIAM DEVINE MD
Provider Business Mailing Address
First Line : PO BOX 3606
Second Line :
City : VALDOSTA
State : GA
Zip : 31604-3606
Country : US
Telephone Number : 229-259-4602
Fax Number : 229-249-5063
Provider Business Practice Location Address
First Line : 2501 N PATTERSON ST
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1735
Country : US
Telephone Number : 229-259-4602
Fax Number : 229-249-5063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 10/13/2011

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Directions to “ JOHN WILLIAM DEVINE MD” Practice Location

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