Provider Demographics
NPI:1295877108
Name:JOHN W. ANDERSON INC
Entity type:Organization
Organization Name:JOHN W. ANDERSON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WICKER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:706-736-2020
Mailing Address - Street 1:1500 JOHNS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4808
Mailing Address - Country:US
Mailing Address - Phone:706-736-2020
Mailing Address - Fax:706-738-2020
Practice Address - Street 1:1500 JOHNS RD STE 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4808
Practice Address - Country:US
Practice Address - Phone:706-736-2020
Practice Address - Fax:706-738-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000445156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0710990001Medicare NSC