Organization
GEORGIA REGENTS UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BILLY NICHOLS MD (STATEWIDE MEDICAL DIRECTOR)
(229) 249-4971
Entity
Organization
Contact information
Practice address
3259 VAL TECH RD, VALDOSTA, GA 31602-9309
(229) 249-4971
Mailing address
9444 DRY LAKE RD, QUITMAN, GA 31643-5925
(229) 263-5863
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
RN179363
GA
Other
Enumeration date
05/18/2015
Last updated
05/18/2015
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