Basic Information
Provider Information | |||||||||
NPI: | 1972575983 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GEE | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3527 N VALDOSTA RD | ||||||||
Address2: |   | ||||||||
City: | VALDOSTA | ||||||||
State: | GA | ||||||||
PostalCode: | 316026407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2292472290 | ||||||||
FaxNumber: | 2292442626 | ||||||||
Practice Location | |||||||||
Address1: | 3527 N VALDOSTA RD | ||||||||
Address2: |   | ||||||||
City: | VALDOSTA | ||||||||
State: | GA | ||||||||
PostalCode: | 316026407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2292472290 | ||||||||
FaxNumber: | 2292442626 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2006 | ||||||||
LastUpdateDate: | 09/17/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 45717 | MN | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XS0117X | 060732 | GA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | ME98645 | FL | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 3671882 | 01 | FL | CIGNA | OTHER | 310433 | 01 | FL | AVMED | OTHER | 9209085 | 01 | FL | AETNA | OTHER | 716130100 | 05 | MN |   | MEDICAID | 96425 | 01 | FL | BCBS FLORIDA | OTHER | 278454800 | 05 | FL |   | MEDICAID |