Provider Demographics
NPI:1538284278
Name:ROBERT A LUDWICK, M.D.PC
Entity Type:Organization
Organization Name:ROBERT A LUDWICK, M.D.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:229-424-0134
Mailing Address - Street 1:118 NORMAN DORMINY DR
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8858
Mailing Address - Country:US
Mailing Address - Phone:229-424-0134
Mailing Address - Fax:229-424-9383
Practice Address - Street 1:118 NORMAN DORMINY DR
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8858
Practice Address - Country:US
Practice Address - Phone:229-424-0134
Practice Address - Fax:229-424-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08BBWTCMedicare ID - Type Unspecified
D09164Medicare UPIN