ENT OF SOUTH GEORGIA SURGERY CENTER LLC (NPI# 1104272780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104272780 |
| Entity Type | Organization |
| Organization Name | ENT OF SOUTH GEORGIA SURGERY CENTER LLC |
| Practice Address |
2805 N Oak St Valdosta GA 31602-5922 |
| Practice Telephone | 2292442562 |
| Practice Fax Number | 2292490000 |
| Mailing Telephone | 2292442562 |
| Mailing Fax Number | 2292490000 |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2017-05-03 |
| Authorized Official Name | DR. RONALD V ALLEN (PRESIDENT) |
| Authorized Official Telephone | 2292442562 |
| Is Organization Subpart | Y |
| Parent Organization Name | EAR, NOSE, THROAT AND ALLERGY ASSOCIATES OF SOUTH GEORGIA PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000655146A | 05 | |
| GA | 000946668A | 05 | |
| GA | 000834589A | 05 |
| Street Address |
2805 N OAK ST |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-5922 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861676892 | Southern Urological Associates | Specialist | 2805 N Oak St, Suite B, Valdosta, GA 31602-5922 | 2007-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| 1457770547 | Physicians Institute for Pain Management Asc, LLC | Clinic/Center | 3312 N Oak Street Ext Ste F, Valdosta, GA 31605-1065 | 2014-04-16 |
| 1689736118 | Voa Ambulatory Surgery Center | Clinic/Center | 3527 B North Valdosta Road, Valdosta, GA 31602 | 2006-12-14 |
| 1538166053 | Southern Ob Gyn Ambulatory Surgery Center, Inc | Clinic/Center | 341 Connell Rd, Valdosta, GA 31602-1471 | 2005-06-30 |
| 1528404803 | Urological Clinic of Valdosta Ambulatory Surgical Center, LLC | Clinic/Center | 3294 N Oak Street Ext, Valdosta, GA 31605-6473 | 2013-05-14 |
| 1316121429 | Plastic Surgery Operative Suite, LLC | Clinic/Center | 230 Northside Dr, Valdosta, GA 31602-1858 | 2007-12-26 |
| 1922280197 | North Oak Ambulatory Surgery Center, LLC | Clinic/Center | 2718 N Oak St, Valdosta, GA 31602-1781 | 2007-11-29 |
| 1912196494 | Valdosta Foot & Ankle Surgery Center, P.C. | Clinic/Center | 2800 N Oak St, Valdosta, GA 31602-1716 | 2007-10-19 |
| 1487782637 | Eyeassociates Surgery Center, Inc | Clinic/Center | 3024 N Patterson St, Valdosta, GA 31602-1711 | 2007-03-01 |
| 1073556338 | Valdosta Podiatry Associates, PC | Clinic/Center | 2718 N Oak St, Valdosta, GA 31602-1781 | 2006-06-14 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.