Provider Demographics
NPI:1760452783
Name:RANGE, JOHN NEEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NEEL
Last Name:RANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:4222 FAIRBANKS DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2811
Practice Address - Country:US
Practice Address - Phone:770-534-6053
Practice Address - Fax:770-534-6695
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA021274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10045373OtherAMERIGROUP
GA6679698OtherCIGNA
GA80075271OtherRR MEDICARE-GRP # CC4177
GA341308OtherWELLCARE
GA4105859OtherAETNA PPO
GA52046825OtherBCBS
GA000252755CMedicaid
GA0100290OtherUNITED HEALTHCARE
GA6679698OtherCIGNA
GA000252755CMedicaid