# UROLOGICAL CLINIC OF VALDOSTA

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

## Provider details

- **NPI number:** 1558341057
- **Authorized official:** MR. DAVID ERIC EATON MPAS (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (229) 242-9003

## Contact information

- **Practice address:** 3000 N PATTERSON ST, VALDOSTA, GA 31602-1711
- **Practice address phone:** (229) 241-1188
- **Practice address fax:** (229) 245-7106
- **Mailing address:** 7494 EULIE WOOD DR, VALDOSTA, GA 31601-1144
- **Mailing address phone:** (229) 247-9124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 018627 | GA | Yes |

## Other

- **Enumeration date:** 01/19/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1032904 | NCCPA | — |