Provider Demographics
NPI:1013027267
Name:FLOYD, WALDO EMERSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDO
Middle Name:EMERSON
Last Name:FLOYD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6317
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208
Mailing Address - Country:US
Mailing Address - Phone:478-745-4206
Mailing Address - Fax:478-254-5463
Practice Address - Street 1:3708 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2404
Practice Address - Country:US
Practice Address - Phone:478-745-4206
Practice Address - Fax:478-254-5463
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029170207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000339875AMedicaid
GA400000472OtherMEDICARE RAILROAD
GA400000472OtherMEDICARE RAILROAD
B79476Medicare UPIN