# SOUTHWELL AMBULATORY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwell Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497330625
- **Authorized official:** TROY BROOKS (SVP/CFO)
- **Authorized official phone:** (229) 353-3397

## Contact information

- **Practice address:** 2922 N OAK ST STE C, VALDOSTA, GA 31602-1885
- **Practice address phone:** (229) 262-6819
- **Mailing address:** 410 CONNELL RD, VALDOSTA, GA 31602-1898
- **Mailing address phone:** (229) 353-6889
- **Mailing address fax:** (229) 219-1631

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/09/2021
- **Last updated:** 10/18/2022