Provider Demographics
NPI:1568663193
Name:TRIPP, JOHN NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NATHAN
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WESLEYAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4116
Mailing Address - Country:US
Mailing Address - Phone:478-474-9550
Mailing Address - Fax:478-474-9550
Practice Address - Street 1:OLD BETHEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:GA
Practice Address - Zip Code:31012
Practice Address - Country:US
Practice Address - Phone:478-358-7315
Practice Address - Fax:478-358-7309
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA15519208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice