NPI 1003857517

Medfast 2

Organisation Legal Medicine (M.D./D.O.) Physician Waycross, GA

Practice location

Address: 1405 Alice St, Waycross, GA 31501-4528
Phone: (912) 285-3157
Fax: (912) 283-2051

Authorised official

Name: Gerardo a Klug
Title: President
Phone: (912) 285-3157

Registered specialties

Legal Medicine (M.D./D.O.) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 209800000X Licence 031778 (GA)

Other Legal Medicine providers in Georgia →

Registry record

NPI: 1003857517
Entity type: Organization
NPI issued: 8 Jun 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.