Provider Demographics
NPI:1629076583
Name:LAYHER, JOHN W JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LAYHER
Suffix:JR
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2470 DANIELS BRIDGE RD STE 251
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6192
Practice Address - Country:US
Practice Address - Phone:706-389-3440
Practice Address - Fax:706-353-2205
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46692207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF73311Medicare UPIN
GA06BDFXCMedicare ID - Type Unspecified
GA511I060170Medicare PIN
GA00816615AOtherAETNA
GA060055060OtherRAILRAOD MEDICARE
GA52746493002OtherBLUE SHIELD
GAF73311Medicare UPIN
GA00816615AMedicaid