Southwell Ambulatory INC
Pediatrics in Valdosta, GA. Organization (NPI-2).
NPI number1962035360
StatusActive
Last updated in NPPESOct 18, 2022
Details
- NPI
- 1962035360
- Entity type
- Organization (NPI-2)
- Legal business name
- Southwell Ambulatory INC
- Organization subpart
- No
- Enumeration date
- Feb 14, 2020
- Certification date
- Oct 18, 2022
- Last updated
- Oct 18, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
Other names
- Southwell Pediatrics Valdosta (Doing Business As)
Practice location
3014 N Patterson StValdosta, GA 31602-1711
Phone 229-242-0194 · Fax 229-242-1785
Mailing address
907 18th St E Ste 400Tifton, GA 31794-3684
Phone 229-353-3422
Authorized official
Troy Brooks
Svp/Cfo
2293533397
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