# JOSE MEDINA MD PC

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

## Provider details

- **NPI number:** 1407047269
- **Authorized official:** DR. JOSE MEDINA MD (OWNER)
- **Authorized official phone:** (229) 247-1667

## Contact information

- **Practice address:** 3334 GREYSTONE WAY, VALDOSTA, GA 31605-1096
- **Practice address phone:** (229) 247-1667
- **Practice address fax:** (229) 247-3456
- **Mailing address:** PO BOX 3550, VALDOSTA, GA 31604-3550
- **Mailing address phone:** (229) 247-1667
- **Mailing address fax:** (229) 247-3456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 041166 | GA | Yes |

## Other

- **Enumeration date:** 08/07/2007
- **Last updated:** 06/15/2010