Provider Demographics
NPI:1720261332
Name:MURRAY, JOHN TONY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TONY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E GRADY ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5157
Mailing Address - Country:US
Mailing Address - Phone:912-764-2020
Mailing Address - Fax:912-681-4768
Practice Address - Street 1:400 E GRADY ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5157
Practice Address - Country:US
Practice Address - Phone:912-764-2020
Practice Address - Fax:912-681-4768
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4433580001Medicare NSC