Provider Demographics
NPI:1235309576
Name:JOHN A VANLANDINGHAM, MD
Entity Type:Organization
Organization Name:JOHN A VANLANDINGHAM, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLANDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:251-296-1849
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-0430
Mailing Address - Country:US
Mailing Address - Phone:251-296-1849
Mailing Address - Fax:
Practice Address - Street 1:1301 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1306
Practice Address - Country:US
Practice Address - Phone:251-296-1849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51006483OtherBLUE CROSS BLUE SHIELD
AL0110557OtherUNITED HEALTH CARE
ALJ966OtherMEDICARE GROUP ID