# VALDOSTA HEALTH & WELLNESS CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366840258
- **Authorized official:** TRACEY Q LIVINGSTON (OWNER)
- **Authorized official phone:** (229) 469-6137

## Contact information

- **Practice address:** 3328 BEMISS RD, VALDOSTA, GA 31605-7014
- **Practice address phone:** (229) 469-6137
- **Practice address fax:** (229) 469-6139
- **Mailing address:** 103 GOOD HOPE CIR, NAYLOR, GA 31641-3657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014