# VALDOSTA MEDICAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1538200035
- **Authorized official:** ROBIN BUSH MANAGER (MANAGER)
- **Authorized official phone:** (229) 242-8480

## Contact information

- **Practice address:** 3207 COUNTRY CLUB DR, VALDOSTA, GA 31605-1029
- **Practice address phone:** (229) 242-8480
- **Practice address fax:** (229) 241-0252
- **Mailing address:** 3207 COUNTRY CLUB DR., VALDOSTA, GA 31605
- **Mailing address phone:** (229) 242-8480
- **Mailing address fax:** (229) 242-0070

## Taxonomy

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

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 01/29/2015