SOUTHWELL AMBULATORY INC (NPI# 1164069472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164069472 |
| Entity Type | Organization |
| Organization Name | SOUTHWELL AMBULATORY INC |
| Other Organization Name | SOUTHWELL GASTROENTEROLOGY |
| Practice Address |
410 Connell Road Valdosta GA 31602-1407 |
| Mailing Address |
907 E 18th Street Suite 400 Tifton GA 31794-3684 |
| Practice Telephone | 2292441570 |
| Practice Fax Number | 2292994291 |
| Mailing Telephone | 2293533422 |
| Mailing Fax Number | 2293536060 |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2020-05-27 |
| Authorized Official Name | LINDA WILSON (VP REVENUE CYCLE) |
| Authorized Official Telephone | 2293533403 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southwell Gastroenterology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3207 Country Club Rd, Valdosta, GA 316051029 | 2292428480 | 2292477539 |
| 814 Northwood Park Dr, Valdosta, GA 316021398 | 2292626800 | 2292477539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693047 | Southwell Ambulatory Inc | Obstetrics & Gynecology | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2020-09-14 |
| 1306466206 | Southwell Ambulatory Inc | Clinic/Center | 901 18th St E, Tifton, GA 31794-3648 | 2020-04-21 |
| 1962035360 | Southwell Ambulatory Inc | Pediatrics | 3014 N Patterson St, Valdosta, GA 31602-1711 | 2020-02-14 |
| 1598304974 | Southwell Ambulatory Inc | Internal Medicine | 2301 N Ashley St, Valdosta, GA 31602-2620 | 2020-01-02 |
| 1720625296 | Southwell Ambulatory Inc | Clinic/Center | 410 Connell Road, Valdosta, GA 31602-1407 | 2019-12-04 |
| 1215574926 | Southwell Ambulatory Inc | Clinic/Center | 3207 Country Club Drive, Valdosta, GA 31605-1029 | 2019-12-02 |
| Street Address |
410 CONNELL ROAD |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215990098 | George Sidney Staton | Internal Medicine | 410 Connell Road, Valdosta, GA 31602 | 2006-04-11 |
| 1720625296 | Southwell Ambulatory Inc | Clinic/Center | 410 Connell Road, Valdosta, GA 31602-1407 | 2019-12-04 |
| 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 | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871827071 | Scott D. Farquhar, Md, PC | Internal Medicine | 3316 Greystone Way, Valdosta, GA 31605-7429 | 2009-09-22 |
| 1568789329 | Maria C Castellano, Md, LLC | Internal Medicine | 2418 N Oak St, Suite J, Valdosta, GA 31602-2576 | 2010-05-03 |
| 1306950100 | Maria C Castellano | Internal Medicine | 2418 N Oak St, Suite G, Valdosta, GA 31602-2576 | 2006-08-18 |
| 1528090156 | William Neville Gee Jr. | Internal Medicine | 2501 N Patterson St, Valdosta, GA 31602-1735 | 2006-07-06 |
| 1699703041 | Eric M Ward | Internal Medicine | 410 Connell Rd, Valdosta, GA 31602-1407 | 2006-06-28 |
| 1174550727 | C Allen Woods | Internal Medicine | 410 Connell Rd, Valdosta, GA 31602-1407 | 2006-06-27 |
| 1114962255 | Valdosta Gastroenterology Associates, LLC | Internal Medicine | 410 Connell Rd, Valdosta, GA 31602-1407 | 2006-06-20 |
| 1316933823 | Edward John Fricker | Internal Medicine | 3207 Country Club Dr, Valdosta, GA 31605-1029 | 2005-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730741448 | Gastro Consultants of Atlanta PC | Internal Medicine | 5669 Peachtree Dunwoody Rd Ste 270, Atlanta, GA 30342-1786 | 2019-07-02 |
| 1023582798 | Digestive Care Consultants, LLC | Internal Medicine | 11315 Johns Creek Pkwy Ste 400, Johns Creek, GA 30097-1517 | 2019-01-16 |
| 1285122465 | Atlanta Premier Gi Endoscopy, LLC | Internal Medicine | 3400 Mcclure Bridge Rd Ste B201, Duluth, GA 30096-8705 | 2018-04-24 |
| 1346762838 | Precision Medical Center PC | Internal Medicine | 4646 N Shallowford Rd Ste 555, Atlanta, GA 30338-6308 | 2017-07-17 |
| 1437510443 | Steven Caras | Internal Medicine | 2682 Bonaire Terrace, Marietta, GA 30066 | 2016-03-18 |
| 1922407162 | Umg Gastroenterology LLC | Internal Medicine | 820 Saint Sebastian Way Ste 2f, Augusta, GA 30901-2636 | 2014-08-13 |
| 1841618881 | Leah G Katta | Internal Medicine | 3400 Old Milton Pkwy Ste 380, Alpharetta, GA 30005-3707 | 2014-04-05 |
| 1306276324 | Candler Gastroenterology | Internal Medicine | 380b Cedar St, Metter, GA 30439-4042 | 2013-11-13 |
| 1215377247 | Deepanshu Jain | Internal Medicine | 8855 Hospital Dr Ste 101, Douglasville, GA 30134-2256 | 2013-07-05 |
| 1114260833 | Shahzad Ahmed | Internal Medicine | 1301 Sigman Rd Ne Ste 170, Conyers, GA 30012-3923 | 2013-04-01 |
| Find all providers with the same taxonomy | ||||
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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.