Provider Demographics
NPI:1679520753
Name:WAYCROSS ORTHOPAEDICS, P.C.
Entity Type:Organization
Organization Name:WAYCROSS ORTHOPAEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-283-8444
Mailing Address - Street 1:PO BOX 2265
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-2265
Mailing Address - Country:US
Mailing Address - Phone:912-283-8444
Mailing Address - Fax:912-283-7132
Practice Address - Street 1:2002 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6210
Practice Address - Country:US
Practice Address - Phone:912-283-8444
Practice Address - Fax:912-283-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30105Medicare UPIN