Provider Demographics
NPI:1083609788
Name:AKRIDGE, JOHN W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:AKRIDGE
Suffix:JR
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 275
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0275
Mailing Address - Country:US
Mailing Address - Phone:912-283-1699
Mailing Address - Fax:912-283-1971
Practice Address - Street 1:1096 WOOD VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-8586
Practice Address - Country:US
Practice Address - Phone:912-283-1699
Practice Address - Fax:912-283-1971
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0273362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000244098FMedicaid
GA000244098EMedicaid
GAP00060623OtherRAILROAD MEDICARE
GA000244098EMedicaid
GA30BDLBKMedicare PIN