Provider Demographics
NPI:1669480513
Name:IMHOFF, JOHN EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWIN
Last Name:IMHOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3215 SHRINE RD
Mailing Address - Street 2:STE 6
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-267-0565
Mailing Address - Fax:912-267-0545
Practice Address - Street 1:3215 SHRINE RD
Practice Address - Street 2:STE 6
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-267-0565
Practice Address - Fax:912-267-0545
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA023995207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180001611OtherMED RR
GA00270971AMedicaid
AI1411951OtherDEA
AI1411951OtherDEA
D29831Medicare UPIN