OrganizationActive
Medfast 2
NPI 1003857517 · Legal Medicine (M.D./D.O.) Physician · Waycross, GA
Provider details
- NPI number
- 1003857517
- Entity type
- Organization
- Primary specialty
- Legal Medicine (M.D./D.O.) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gerardo Klug, President(912) 285-3157
- License
- 031778 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1405 Alice St
Waycross, GA 31501-4528
Phone: (912) 285-3157
Fax: (912) 283-2051
Approximate (ZIP-level) locationGet directions
Mailing address
1405 Alice St
Waycross, GA 31501-4528
Registry dates
- Enumerated
- 2006-06-08
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.