Provider Demographics
NPI:1982663381
Name:FERNANDO, ORLANDO V (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:V
Last Name:FERNANDO
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:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-2070
Mailing Address - Country:US
Mailing Address - Phone:912-367-9841
Mailing Address - Fax:
Practice Address - Street 1:105 E TOLLISON ST STE B
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0150
Practice Address - Country:US
Practice Address - Phone:912-367-0102
Practice Address - Fax:912-367-9966
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000777543AMedicaid
110168355OtherRAILROAD MEDICARE
110168355OtherRAILROAD MEDICARE
GA000777543AMedicaid