Southwell Ambulatory INC
Internal Medicine, Gastroenterology in Valdosta, GA. Organization (NPI-2).
NPI number1164069472
StatusActive
Last updated in NPPESOct 27, 2025
Details
- NPI
- 1164069472
- Entity type
- Organization (NPI-2)
- Legal business name
- Southwell Ambulatory INC
- Organization subpart
- No
- Enumeration date
- Dec 5, 2019
- Certification date
- Oct 27, 2025
- Last updated
- Oct 27, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0100X | Internal Medicine, Gastroenterology | – | – | Yes |
Other names
- Southwell Gastroenterology (Doing Business As)
Practice location
2922 N Oak St Ste CValdosta, GA 31602-1885
Phone 229-244-1570 · Fax 229-299-4291
Mailing address
Po Box 2650Tifton, GA 31793-2650
Phone 229-353-3422 · Fax 229-353-6060
Other practice locations
3790 Old Us 41 N Ste B
Valdosta, GA 31602-6866
Valdosta, GA 31602-6866
Phone 229-262-6800
Authorized official
Troy Brooks
Svp/Cfo
2293533397
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