Provider Demographics
NPI:1245220128
Name:ERDMAN, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:ERDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:140 BATTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4006
Mailing Address - Country:US
Mailing Address - Phone:706-861-7070
Mailing Address - Fax:
Practice Address - Street 1:140 BATTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4006
Practice Address - Country:US
Practice Address - Phone:706-861-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024929207Y00000X
GA035251207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00459775BMedicaid
TN3872367Medicare ID - Type UnspecifiedMEDICARE NUMBER
E64901Medicare UPIN
GA04BDBGWMedicare ID - Type UnspecifiedMEDICARE NUMBER