# SOUTHERN SKIN & WELLNESS CENTER

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

## Provider details

- **NPI number:** 1720224298
- **Authorized official:** DR. RICHARD ANTHONY AMBROZIC MD (PRESIDENT)
- **Authorized official phone:** (229) 242-9310

## Contact information

- **Practice address:** 3321 N VALDOSTA RD STE B, VALDOSTA, GA 31602-1685
- **Practice address phone:** (229) 242-9310
- **Practice address fax:** (229) 242-9714
- **Mailing address:** 3321 N VALDOSTA RD STE B, VALDOSTA, GA 31602-1685
- **Mailing address phone:** (229) 242-9310
- **Mailing address fax:** (229) 242-9714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2009
- **Last updated:** 03/16/2015