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Organization
UROLOGICAL CLINIC OF VALDOSTA
Active
Organization
UROLOGICAL CLINIC OF VALDOSTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ERIC EATON MPAS (PHYSICIAN ASSISTANT)
(229) 242-9003
Entity
Organization
Contact information
Practice address
3000 N PATTERSON ST, VALDOSTA, GA 31602-1711
(229) 241-1188
(229) 245-7106
Mailing address
7494 EULIE WOOD DR, VALDOSTA, GA 31601-1144
(229) 247-9124
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
018627
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032904
NCCPA
—
Enumeration date
01/19/2006
Last updated
08/22/2020
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