Organization

Medfast 2

Legal Medicine (M.D./D.O.) Physician in Waycross, GA(View on Map)

Legal Business Name

Medfast 2

NPI Number

1003857517

NPI Type

Organization

Enumeration Date

06/08/2006

Specialties

(Taxonomies)

Code

209800000X

Primary Taxonomy

Yes

Licenses

State

Georgia

License Number

031778

Contact
Information

Purpose

Mailing
Location

Address

1405 ALICE ST
1405 ALICE ST

City

Waycross
Waycross

State

GA
GA

Postal Code

31501-4528
31501-4528

Country

US
US

Telephone Number

(912) 285-3157
(912) 285-3157

Authorized Official

Name

Gerardo Klug

Title or Position

PRESIDENT

Telephone Number

(912) 285-3157

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/22/2020

Provider Address