Organization
SOUTHERN PODIATRY GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AVIS GRIFFIN (OFFICE MANAGER)
(229) 242-3668
Entity
Organization
Contact information
Practice address
820 LOVE AVE, SUITE B, TIFTON, GA 31794-4071
(229) 382-5599
Mailing address
2718 N OAK ST, VALDOSTA, GA 31602-1781
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300026567A
—
GA
Enumeration date
05/22/2008
Last updated
12/01/2009
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