Provider Demographics
NPI:1225241649
Name:WINDHAM, JOHN GEARY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GEARY
Last Name:WINDHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 SE COUNTRY CLUB RD.
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-3327
Mailing Address - Country:US
Mailing Address - Phone:386-755-8909
Mailing Address - Fax:
Practice Address - Street 1:373 SE COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4987
Practice Address - Country:US
Practice Address - Phone:386-755-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant