Medfast 2

Primary specialty

Legal Medicine (M.D./D.O.) PhysicianTaxonomy code 209800000X

License

031778 Issued in GA

Legal business name

MEDFAST 2

Practice address

1405 Alice St
Waycross, GA 31501-4528

Phone

(912) 285-3157

Fax

(912) 283-2051

NPI assigned

Jun 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gerardo A Klug, M.D.NPI 1205878600

Title

President

Phone

(912) 285-3157

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerardo Alberto Klug, M.D.

  • Legal Medicine (M.D./D.O.) Physician
  • Waycross, GA
  • NPI 1205878600
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003857517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014528",
            "telephone_number": "912-285-3157",
            "fax_number": "912-283-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014528",
            "telephone_number": "912-285-3157",
            "fax_number": "912-283-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFAST 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KLUG",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-285-3157",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "209800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "031778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McKinney Medical Center Inc
• McKinney Medical Center Inc
• Anna Grace McLeod, PHARM. D.
• Erin McQuaig
• Med Staff Inc
• Medical Mobility Solutions, Inc.
• Medical Treatment Consultants LLC
• Lola A Medlin-Goettie, HOME HEALTH CARE
• Ches Melton, PHARMD
• Memorial Careone Home Health Services Inc

• Legal Medicine (M.D./D.O.) Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Legal Medicine (M.D./D.O.) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.