John  I  Waldrop    MD
Contract Details
Hughston Clinic--Vidalia
Facility name
Provider ID
P000001808
NPI
1013950120
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
9/22/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
Location Details
Address
1811 Manning Drive
Vidalia, GA 30474
United States
County
Toombs
Phone
9125380333 (Phone)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address