Provider Demographics
NPI:1346348133
Name:HOUSE, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5473
Mailing Address - Country:US
Mailing Address - Phone:229-520-7115
Mailing Address - Fax:229-236-0871
Practice Address - Street 1:9355 MAIN ST S
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553-6159
Practice Address - Country:US
Practice Address - Phone:912-462-6222
Practice Address - Fax:912-462-6203
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA011959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA032781OtherBLUESHIELD
GA00038651AMedicaid
GA00038651AMedicaid